Provider Demographics
NPI:1326135542
Name:YOGIDARSHAN CORP
Entity Type:Organization
Organization Name:YOGIDARSHAN CORP
Other - Org Name:SUBURBAN PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DHIRUBHAI
Authorized Official - Middle Name:T
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-954-9896
Mailing Address - Street 1:2385 ALAMANCE DR
Mailing Address - Street 2:
Mailing Address - City:WEST CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60185-6450
Mailing Address - Country:US
Mailing Address - Phone:630-954-9896
Mailing Address - Fax:
Practice Address - Street 1:185 E ARMY TRAIL RD
Practice Address - Street 2:SUITE 'A'
Practice Address - City:GLENDALE HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60139-1697
Practice Address - Country:US
Practice Address - Phone:630-237-4210
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-08
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL54016064333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL5833490001Medicare NSC