Provider Demographics
NPI:1023043643
Name:JW PHARMACY & DME INC
Entity Type:Organization
Organization Name:JW PHARMACY & DME INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WAFA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAKI
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:708-588-0300
Mailing Address - Street 1:PO BOX 744
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:IL
Mailing Address - Zip Code:60525-0744
Mailing Address - Country:US
Mailing Address - Phone:708-588-0300
Mailing Address - Fax:708-588-0302
Practice Address - Street 1:5101 WILLOW SPRINGS RD
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:IL
Practice Address - Zip Code:60525-2600
Practice Address - Country:US
Practice Address - Phone:708-588-0300
Practice Address - Fax:708-588-0302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL054015550333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1477911OtherNCPDP NUMBER
ILBA9460306OtherDEA NUMBER
IL1477911OtherNCPDP NUMBER
ILBA9460306OtherDEA NUMBER