Provider Demographics
NPI:1194183517
Name:NORTH PARK PHARMACY LLC
Entity Type:Organization
Organization Name:NORTH PARK PHARMACY LLC
Other - Org Name:NORTH PARK PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST-IN-CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:ZAHEER
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-654-3658
Mailing Address - Street 1:3324 W FOSTER AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-4813
Mailing Address - Country:US
Mailing Address - Phone:773-654-3658
Mailing Address - Fax:773-624-7635
Practice Address - Street 1:3324 W FOSTER AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-4813
Practice Address - Country:US
Practice Address - Phone:773-654-3658
Practice Address - Fax:773-624-7635
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-29
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
IL0540196653336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2157846OtherPK
2157846OtherPK