Provider Demographics
NPI:1023031473
Name:J &J PHARMACY LTD.
Entity Type:Organization
Organization Name:J &J PHARMACY LTD.
Other - Org Name:J & J PHARMACY LTD.
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JAGDISH
Authorized Official - Middle Name:P
Authorized Official - Last Name:DESAI
Authorized Official - Suffix:
Authorized Official - Credentials:R PH
Authorized Official - Phone:773-778-2356
Mailing Address - Street 1:2001 W 69TH STREET
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60636
Mailing Address - Country:US
Mailing Address - Phone:773-778-2356
Mailing Address - Fax:
Practice Address - Street 1:2001 W 69TH STREET
Practice Address - Street 2:CLINIC PHARMACY
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60636
Practice Address - Country:US
Practice Address - Phone:773-778-2356
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051033681183500000X
IL054014217333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes333600000XSuppliersPharmacy
No183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL=========001Medicaid