Provider Demographics
NPI:1235405663
Name:ELGIN WEST PHARMACY INC
Entity Type:Organization
Organization Name:ELGIN WEST PHARMACY INC
Other - Org Name:ELGIN WEST PHARMACY INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMICIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:ARVIND
Authorized Official - Middle Name:
Authorized Official - Last Name:SURTI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:847-627-4600
Mailing Address - Street 1:1554 TODD FARM DR
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-1287
Mailing Address - Country:US
Mailing Address - Phone:847-627-4600
Mailing Address - Fax:847-627-4652
Practice Address - Street 1:1554 TODD FARM DR
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-1287
Practice Address - Country:US
Practice Address - Phone:847-627-4600
Practice Address - Fax:847-627-4652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-29
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL054-0179313336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2134449OtherPK
2134449OtherPK
6727270001Medicare NSC