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NPI Code Detail

MEDICARE: PRIMARY PHARMACY INC

MEDICARE: PRIMARY PHARMACY INC
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
23336C0002XClinic Pharmacy054014258IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12025128OTHERPK

General Provider Information

NPI Number : 1649331711
Entity Type Code : Organization
Provider Name (Legal Business Name) : PRIMARY PHARMACY INC
Provider Business Mailing Address
First Line : 2025 S CHICAGO ST
Second Line :
City : JOLIET
State : IL
Zip : 60436-3172
Country : US
Telephone Number : 815-723-0300
Fax Number : 815-723-2308
Provider Business Practice Location Address
First Line : 2025 S CHICAGO ST
Second Line :
City : JOLIET
State : IL
Zip : 60436-3172
Country : US
Telephone Number : 815-723-0300
Fax Number : 815-723-2308
Authorized Official
Title or Position : MANAGER
Name : HARISH BHATT
Credential : RPH
Telephone Number : 815-725-1102
Provider Enumeration Date : 12/13/2006
Last Update Date : 03/16/2016

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Directions to “PRIMARY PHARMACY INC ” Practice Location

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