Provider Demographics
NPI:1003387226
Name:SURECARE PHARMACY 2 INC
Entity Type:Organization
Organization Name:SURECARE PHARMACY 2 INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST INCHARGE
Authorized Official - Prefix:
Authorized Official - First Name:RACHIT
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:732-910-2949
Mailing Address - Street 1:32 WILLOW BAY DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-7114
Mailing Address - Country:US
Mailing Address - Phone:732-910-2949
Mailing Address - Fax:
Practice Address - Street 1:4700 S CALIFORNIA AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60632
Practice Address - Country:US
Practice Address - Phone:732-910-2949
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy