Provider Demographics
NPI:1043284904
Name:HINSDALE PHARMACY ASSOCIATES, INC.
Entity Type:Organization
Organization Name:HINSDALE PHARMACY ASSOCIATES, INC.
Other - Org Name:ELM PLAZA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:HIEMENZ
Authorized Official - Suffix:
Authorized Official - Credentials:RPH, MBA, CGP
Authorized Official - Phone:630-455-4377
Mailing Address - Street 1:908 N ELM ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-3635
Mailing Address - Country:US
Mailing Address - Phone:630-455-4377
Mailing Address - Fax:630-455-4373
Practice Address - Street 1:908 N ELM ST
Practice Address - Street 2:SUITE 100
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-3635
Practice Address - Country:US
Practice Address - Phone:630-455-4377
Practice Address - Fax:630-455-4373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-15
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1473987OtherNCPDP
IL1473987OtherNCPDP
IL201643Medicare PIN
IL=========001Medicaid