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General NPI Number Information
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NPI Number | 1952679599
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Entity Type | Organization
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Legal Business Name | PRIMISHA PHRAMACY LLC
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Dates
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Enumeration Date | 12/11/2011
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Last Update Date | 10/20/2016
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Provider Practice Location Address
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Address Line | 750 FLETCHER DR STE 103
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City | ELGIN
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State | IL
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Zip | 60123-4703
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Country | US
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Telephone | 847-742-6700
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Fax | 847-742-6767
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Provider Business Mailing Address
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Address Line | 750 FLETCHER DR STE 103
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City | ELGIN
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State | IL
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Zip | 60123-4703
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Country | US
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Telephone | 847-742-6700
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Fax | 847-742-6767
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Authorized Official
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Title or Position | PRESIDENT
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Name | PRITESH PATEL
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Credential | RPH
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Telephone | 248-925-8496
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 054.017807
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License Number State | IL
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