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General NPI Number Information
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NPI Number | 1831516970
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Entity Type | Organization
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Legal Business Name | MIDWEST PHARMACY SERVICES LLC
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Dates
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Enumeration Date | 03/26/2014
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Last Update Date | 02/12/2015
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Provider Practice Location Address
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Address Line | 5470 W MADISON ST
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City | CHICAGO
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State | IL
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Zip | 60644-4031
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Country | US
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Telephone | 773-379-7773
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Fax |
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Provider Business Mailing Address
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Address Line | 5470 W MADISON ST
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City | CHICAGO
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State | IL
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Zip | 60644-4031
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Country | US
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Telephone | 773-379-7773
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Fax | 773-379-1020
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Authorized Official
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Title or Position | SHAREHOLDER
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Name | MR. TILAK MARWAHA
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Credential |
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Telephone | 773-275-3769
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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