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General NPI Number Information
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NPI Number | 1982212635
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Entity Type | Organization
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Legal Business Name | GRAND PHARMACY LLC
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Dates
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Enumeration Date | 07/20/2020
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Last Update Date | 07/20/2020
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Provider Practice Location Address
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Address Line | 229 W GRAND AVE STE F
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City | BENSENVILLE
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State | IL
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Zip | 60106-3365
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Country | US
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Telephone | 630-422-3162
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Fax | 630-422-1927
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Provider Business Mailing Address
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Address Line | 229 W GRAND AVE STE F
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City | BENSENVILLE
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State | IL
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Zip | 60106-3365
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Country | US
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Telephone | 630-422-3162
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Fax | 630-422-1927
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Authorized Official
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Title or Position | OWNER
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Name | BEHROUZ HOGHOUGHI
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Credential |
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Telephone | 312-622-2156
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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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