Provider Demographics
NPI:1902417207
Name:IPACK PHARMACY LLC
Entity Type:Organization
Organization Name:IPACK PHARMACY LLC
Other - Org Name:IPACK PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUNNY
Authorized Official - Middle Name:DINESHKUMAR
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:262-649-3900
Mailing Address - Street 1:17000 W NORTH AVE STE 108W
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-4423
Mailing Address - Country:US
Mailing Address - Phone:262-649-3900
Mailing Address - Fax:262-649-3076
Practice Address - Street 1:17000 W NORTH AVE STE 108W
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-4423
Practice Address - Country:US
Practice Address - Phone:262-649-3900
Practice Address - Fax:262-649-3076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-11
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy