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NPI Code Detail

MEDICARE: VALUE VILLAGE PHARMACY

MEDICARE: VALUE VILLAGE PHARMACY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
13336C0003XCommunity/Retail Pharmacy
2333600000XPharmacy54011255IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11455840OTHEROTHER ID NUMBER-COMMERCIAL NUMBER

General Provider Information

NPI Number : 1043231095
Entity Type Code : Organization
Provider Name (Legal Business Name) : VALUE VILLAGE PHARMACY
Provider Business Mailing Address
First Line : 618 E SIBLEY BLVD
Second Line :
City : DOLTON
State : IL
Zip : 60419-2599
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 618 E SIBLEY BLVD
Second Line :
City : DOLTON
State : IL
Zip : 60419-2599
Country : US
Telephone Number : 708-849-3900
Fax Number : 708-849-1930
Authorized Official
Title or Position : PRESIDENT
Name : OM DHINGRA
Credential :
Telephone Number : 708-849-3900
Provider Enumeration Date : 07/22/2006
Last Update Date : 04/20/2008

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Directions to “VALUE VILLAGE PHARMACY ” Practice Location

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