Provider Demographics
NPI:1619285509
Name:SIMPLE RX INC.
Entity Type:Organization
Organization Name:SIMPLE RX INC.
Other - Org Name:HWY 72 PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RUPESH
Authorized Official - Middle Name:BHARAT
Authorized Official - Last Name:MANEK
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:815-522-3898
Mailing Address - Street 1:PO BOX 4
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:IL
Mailing Address - Zip Code:60146-0004
Mailing Address - Country:US
Mailing Address - Phone:815-522-3898
Mailing Address - Fax:815-522-3859
Practice Address - Street 1:527 WEST MAIN ST. UNIT 1W
Practice Address - Street 2:UNIT 1W
Practice Address - City:KIRKLAND
Practice Address - State:IL
Practice Address - Zip Code:60146
Practice Address - Country:US
Practice Address - Phone:815-522-3898
Practice Address - Fax:815-522-3859
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-14
Last Update Date:2010-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0540175563336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy