Provider Demographics
NPI:1407175797
Name:FIRST FAMILY PHARMACY INC
Entity Type:Organization
Organization Name:FIRST FAMILY PHARMACY INC
Other - Org Name:FIRST FAMILY PHARMACY, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:ALFREDO
Authorized Official - Middle Name:
Authorized Official - Last Name:VILLASENOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-338-7000
Mailing Address - Street 1:2140 W DEVON AVE STE 1W
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659-2256
Mailing Address - Country:US
Mailing Address - Phone:773-338-7000
Mailing Address - Fax:773-338-7111
Practice Address - Street 1:2140 W DEVON AVE STE 1W
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-2256
Practice Address - Country:US
Practice Address - Phone:773-338-7000
Practice Address - Fax:773-338-7111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-26
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL054.0173353336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2125271OtherPK
1484524OtherNCPDP PROVIDER IDENTIFICATION NUMBER