Provider Demographics
NPI:1528212479
Name:KND HEALTH CARE SERVICES SC
Entity Type:Organization
Organization Name:KND HEALTH CARE SERVICES SC
Other - Org Name:PRIME CARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEEPAK
Authorized Official - Middle Name:T
Authorized Official - Last Name:DATTANI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:630-354-6300
Mailing Address - Street 1:PO BOX 570
Mailing Address - Street 2:
Mailing Address - City:BENSENVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60106-0570
Mailing Address - Country:US
Mailing Address - Phone:630-354-6300
Mailing Address - Fax:630-354-6309
Practice Address - Street 1:420 COUNTRY CLUB DR
Practice Address - Street 2:
Practice Address - City:BENSENVILLE
Practice Address - State:IL
Practice Address - Zip Code:60106-1507
Practice Address - Country:US
Practice Address - Phone:630-354-6300
Practice Address - Fax:630-354-6305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-05
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2118093OtherPK
IL=========002Medicaid