Provider Demographics
NPI:1093417628
Name:LITTLE VILLAGE PHARMACY INC
Entity Type:Organization
Organization Name:LITTLE VILLAGE PHARMACY INC
Other - Org Name:PROPACK PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MITESH
Authorized Official - Middle Name:D
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-912-3201
Mailing Address - Street 1:3811 W 26TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60623-3808
Mailing Address - Country:US
Mailing Address - Phone:773-522-2121
Mailing Address - Fax:
Practice Address - Street 1:3811 W 26TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60623-3808
Practice Address - Country:US
Practice Address - Phone:773-522-2121
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LITTLE VILLAGE PHARMACY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-03-20
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy