Provider Demographics
NPI:1073608998
Name:ORSINI PHARMACEUTICAL SERVICES, LLC
Entity Type:Organization
Organization Name:ORSINI PHARMACEUTICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:
Authorized Official - Last Name:TOM
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:847-734-7373
Mailing Address - Street 1:1107 NICHOLAS BLVD
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE VILLAGE
Mailing Address - State:IL
Mailing Address - Zip Code:60007-2516
Mailing Address - Country:US
Mailing Address - Phone:847-734-7373
Mailing Address - Fax:847-725-8104
Practice Address - Street 1:1107 NICHOLAS BLVD
Practice Address - Street 2:
Practice Address - City:ELK GROVE VILLAGE
Practice Address - State:IL
Practice Address - Zip Code:60007-2516
Practice Address - Country:US
Practice Address - Phone:847-734-7373
Practice Address - Fax:847-734-1822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
No333600000XSuppliersPharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL054.020692OtherPHARMACY LICENSE
IL1477416OtherNCPDP
IL1477416OtherNCPDP
ILB08928256OtherDEA NUMBER
ILB08928256OtherDEA NUMBER
IN200521980Medicaid
IL=========0001MedicaidPUBLIC AID #
IL=========0001MedicaidPUBLIC AID #