Provider Demographics
NPI:1558627323
Name:QUEENSWAY ENT. INC.
Entity Type:Organization
Organization Name:QUEENSWAY ENT. INC.
Other - Org Name:QUEENSWAY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHMOND
Authorized Official - Middle Name:
Authorized Official - Last Name:NIMAKO-BOATENG
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:630-236-9502
Mailing Address - Street 1:PO BOX 4863
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60567-4863
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:691 COLLINS ST
Practice Address - Street 2:SUITE 1B
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60432-1856
Practice Address - Country:US
Practice Address - Phone:630-236-9502
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-05
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL3336C0003X, 3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy