Provider Demographics
NPI:1518328186
Name:BARTLETT PHARMACY INC
Entity Type:Organization
Organization Name:BARTLETT PHARMACY INC
Other - Org Name:BARTLETT PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER/PIC
Authorized Official - Prefix:
Authorized Official - First Name:NAHREN
Authorized Official - Middle Name:
Authorized Official - Last Name:KHOSHABA
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:630-855-5178
Mailing Address - Street 1:300 W BARTLETT AVE
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:IL
Mailing Address - Zip Code:60103-4002
Mailing Address - Country:US
Mailing Address - Phone:630-855-5178
Mailing Address - Fax:630-855-5672
Practice Address - Street 1:300 W BARTLETT AVE
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:IL
Practice Address - Zip Code:60103-4002
Practice Address - Country:US
Practice Address - Phone:630-855-5178
Practice Address - Fax:630-855-5672
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-10
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
IL0540198503336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2159026OtherPK
2159026OtherPK