Provider Demographics
NPI:1376846063
Name:BERWYN COMMUNITY PHARMACY
Entity Type:Organization
Organization Name:BERWYN COMMUNITY PHARMACY
Other - Org Name:RIVERSIDE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:KALPESH
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:630-550-0565
Mailing Address - Street 1:7234 OGDEN AVE
Mailing Address - Street 2:SUITE 1E
Mailing Address - City:RIVERSIDE
Mailing Address - State:IL
Mailing Address - Zip Code:60546-2269
Mailing Address - Country:US
Mailing Address - Phone:630-550-0565
Mailing Address - Fax:
Practice Address - Street 1:7234 OGDEN AVE
Practice Address - Street 2:SUITE 1E
Practice Address - City:RIVERSIDE
Practice Address - State:IL
Practice Address - Zip Code:60546-2269
Practice Address - Country:US
Practice Address - Phone:630-550-0565
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-17
Last Update Date:2010-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL054-0175553336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy