Provider Demographics
NPI:1083090575
Name:UPTOWN PHARMACY, INC.
Entity Type:Organization
Organization Name:UPTOWN PHARMACY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:EDUARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:ALPIZAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-944-0525
Mailing Address - Street 1:4535 N SHERIDAN RD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-7611
Mailing Address - Country:US
Mailing Address - Phone:773-944-0525
Mailing Address - Fax:773-944-0632
Practice Address - Street 1:4535 N SHERIDAN RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-7611
Practice Address - Country:US
Practice Address - Phone:773-944-0525
Practice Address - Fax:773-944-0632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-06
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL054-019426332B00000X, 333600000X, 3336C0003X, 3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL054-019426OtherIL DEPT OF FINANCIAL AND PROFESSIONAL REGULATION