Provider Demographics
NPI:1518433077
Name:PRISM PHARMACY LLC
Entity Type:Organization
Organization Name:PRISM PHARMACY LLC
Other - Org Name:PRISM PHARMACY ELGIN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:RAJUL
Authorized Official - Middle Name:
Authorized Official - Last Name:SHETH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:224-392-0727
Mailing Address - Street 1:1795 GRANDSTAND PL STE 2A
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-4980
Mailing Address - Country:US
Mailing Address - Phone:224-856-5354
Mailing Address - Fax:224-856-5215
Practice Address - Street 1:1795 GRANDSTAND PL STE 2A
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-4980
Practice Address - Country:US
Practice Address - Phone:224-856-5354
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-22
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy