Provider Demographics
NPI:1649224726
Name:NORTH TOWN PHARMACY INC
Entity Type:Organization
Organization Name:NORTH TOWN PHARMACY INC
Other - Org Name:NORTHTOWN PHARMACY INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ARUN
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-465-1144
Mailing Address - Street 1:6201 N CALIFORNIA AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659-2699
Mailing Address - Country:US
Mailing Address - Phone:773-465-1144
Mailing Address - Fax:773-465-6675
Practice Address - Street 1:6201 N CALIFORNIA AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-2699
Practice Address - Country:US
Practice Address - Phone:773-465-1144
Practice Address - Fax:773-465-6675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-21
Last Update Date:2009-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
IL054119633336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1465536OtherNCPDP PROVIDER IDENTIFICATION NUMBER
IL=========001Medicaid
1465536OtherNCPDP PROVIDER IDENTIFICATION NUMBER