Provider Demographics
NPI:1275775330
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:PHARMACY MANAGER
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:708-303-5151
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:773-522-4040
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:773-522-4040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-03
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
IL0540166363336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2119668OtherPK