Provider Demographics
NPI:1033476494
Name:SIMPLE RX SOLUTIONS INC
Entity Type:Organization
Organization Name:SIMPLE RX SOLUTIONS INC
Other - Org Name:AMBOY HOMETOWN PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:RUPESH
Authorized Official - Middle Name:
Authorized Official - Last Name:MANEK
Authorized Official - Suffix:
Authorized Official - Credentials:BSCPHARM
Authorized Official - Phone:630-926-1844
Mailing Address - Street 1:221 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:AMBOY
Mailing Address - State:IL
Mailing Address - Zip Code:61310-1439
Mailing Address - Country:US
Mailing Address - Phone:815-857-7005
Mailing Address - Fax:815-857-7119
Practice Address - Street 1:221 E MAIN ST
Practice Address - Street 2:
Practice Address - City:AMBOY
Practice Address - State:IL
Practice Address - Zip Code:61310-1439
Practice Address - Country:US
Practice Address - Phone:815-857-7005
Practice Address - Fax:815-857-7119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-23
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
IL054.0179643336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2135900OtherPK
2135900OtherPK