Provider Demographics
NPI:1114052073
Name:MAB PHARMACY INC
Entity Type:Organization
Organization Name:MAB PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST INCHARGE
Authorized Official - Prefix:MR
Authorized Official - First Name:BHARAT
Authorized Official - Middle Name:V
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:773-342-5878
Mailing Address - Street 1:2643 W DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-7276
Mailing Address - Country:US
Mailing Address - Phone:773-348-5878
Mailing Address - Fax:773-342-5878
Practice Address - Street 1:2643 W DIVISION ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-7276
Practice Address - Country:US
Practice Address - Phone:773-348-5878
Practice Address - Fax:773-342-5878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL054014043332B00000X
IL054-014043333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL4587580001Medicare NSC