MEDICARE: 108 PHARMA CORP

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
1	3336C0003X	Community/Retail Pharmacy
2	3336M0002X	Mail Order Pharmacy

General Provider Information

NPI Number	:	1558163923
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	108 PHARMA CORP

Provider Business Mailing Address
First Line	:	300 MADSEN DRIVE
Second Line	:	SUITE 101 ROOM 201
City	:	BLOOMINGDALE
State	:	IL
Zip	:	60108
Country	:	US
Telephone Number	:	630-423-8511
Fax Number	:	630-423-8522

Provider Business Practice Location Address
First Line	:	300 MADSEN DRIVE
Second Line	:	SUITE 101 ROOM 201
City	:	BLOOMINGDALE
State	:	IL
Zip	:	60108
Country	:	US
Telephone Number	:	630-423-8511
Fax Number	:	630-423-8522

Authorized Official
Title or Position	:	CEO
Name	:	DINESH RAJANI
Credential	:
Telephone Number	:	847-997-8451

Provider Enumeration Date	:	03/26/2025
Last Update Date	:	06/02/2026

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Directions to “108 PHARMA CORP ” Practice Location

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