Provider Demographics
NPI:1104217389
Name:ADDISON PHARMACY, INC
Entity Type:Organization
Organization Name:ADDISON PHARMACY, INC
Other - Org Name:WESTCHESTER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KERUL
Authorized Official - Middle Name:
Authorized Official - Last Name:MEHTA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:630-543-0988
Mailing Address - Street 1:4009 WARREN AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:BELLWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60104-2066
Mailing Address - Country:US
Mailing Address - Phone:708-897-2424
Mailing Address - Fax:708-897-2426
Practice Address - Street 1:4009 WARREN AVE STE 100
Practice Address - Street 2:
Practice Address - City:BELLWOOD
Practice Address - State:IL
Practice Address - Zip Code:60104-2066
Practice Address - Country:US
Practice Address - Phone:708-897-2424
Practice Address - Fax:708-897-2426
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-10
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy