Provider Demographics
NPI:1689019887
Name:GRAND PHARMACY LLC
Entity Type:Organization
Organization Name:GRAND PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALIKSANDR
Authorized Official - Middle Name:
Authorized Official - Last Name:BEKETAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-733-8044
Mailing Address - Street 1:2158 W GRAND AVE
Mailing Address - Street 2:101
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-1571
Mailing Address - Country:US
Mailing Address - Phone:312-733-8044
Mailing Address - Fax:312-733-8062
Practice Address - Street 1:2158 W GRAND AVE
Practice Address - Street 2:101
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-1571
Practice Address - Country:US
Practice Address - Phone:312-733-8044
Practice Address - Fax:312-733-8062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-02
Last Update Date:2014-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy