Provider Demographics
NPI:1043502107
Name:GREENBROOK PHARMACY LLC
Entity Type:Organization
Organization Name:GREENBROOK PHARMACY LLC
Other - Org Name:GREENBROOK PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHETAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:630-830-3784
Mailing Address - Street 1:1806 IRVING PARK RD
Mailing Address - Street 2:
Mailing Address - City:HANOVER PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60133-3254
Mailing Address - Country:US
Mailing Address - Phone:630-830-3784
Mailing Address - Fax:630-830-3788
Practice Address - Street 1:1806 IRVING PARK RD
Practice Address - Street 2:
Practice Address - City:HANOVER PARK
Practice Address - State:IL
Practice Address - Zip Code:60133-3254
Practice Address - Country:US
Practice Address - Phone:630-830-3784
Practice Address - Fax:630-830-3788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-09
Last Update Date:2014-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy