Provider Demographics
NPI:1629281266
Name:MARKET SQUARE PHARMACY
Entity Type:Organization
Organization Name:MARKET SQUARE PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MITESH
Authorized Official - Middle Name:D
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:847-803-2020
Mailing Address - Street 1:1460 MARKET ST STE 200
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-4645
Mailing Address - Country:US
Mailing Address - Phone:847-803-2020
Mailing Address - Fax:847-803-2022
Practice Address - Street 1:1460 MARKET ST STE 200
Practice Address - Street 2:
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-4645
Practice Address - Country:US
Practice Address - Phone:847-803-2020
Practice Address - Fax:847-803-2022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL05416090183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL5895080001Medicare NSC