Provider Demographics
NPI:1609142405
Name:ACCESS CARE LTC PHARMACY INC
Entity Type:Organization
Organization Name:ACCESS CARE LTC PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:
Authorized Official - Last Name:SHARSHON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-210-5307
Mailing Address - Street 1:PO BOX 4860
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60567-4860
Mailing Address - Country:US
Mailing Address - Phone:630-874-1988
Mailing Address - Fax:630-541-8275
Practice Address - Street 1:5120 BELMONT RD
Practice Address - Street 2:SUITE C
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-4332
Practice Address - Country:US
Practice Address - Phone:630-874-1988
Practice Address - Fax:630-541-8275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-26
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL054-0178953336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL054-017895OtherPHARMACY LICENSE