Provider Demographics
NPI:1518116219
Name:LAVIR PHARMACY INC
Entity Type:Organization
Organization Name:LAVIR PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER RPH IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:KIRITKUMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:773-853-2374
Mailing Address - Street 1:4959 W BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60641-4332
Mailing Address - Country:US
Mailing Address - Phone:773-853-2374
Mailing Address - Fax:773-853-2365
Practice Address - Street 1:4959 W BELMONT AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60641-4332
Practice Address - Country:US
Practice Address - Phone:773-853-2374
Practice Address - Fax:773-853-2365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-17
Last Update Date:2017-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0002X
IL0540164893336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2117316OtherPK