Provider Demographics
NPI:1962452417
Name:G.A.PHARMACY
Entity Type:Organization
Organization Name:G.A.PHARMACY
Other - Org Name:CHOICE RX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:DR
Authorized Official - First Name:MAHENDRA
Authorized Official - Middle Name:C
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:708-788-3166
Mailing Address - Street 1:7036 W. CERMAK RD
Mailing Address - Street 2:
Mailing Address - City:BERWYN
Mailing Address - State:IL
Mailing Address - Zip Code:60402-2197
Mailing Address - Country:US
Mailing Address - Phone:708-788-3166
Mailing Address - Fax:708-788-3181
Practice Address - Street 1:7036 CERMAK RD
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402-2197
Practice Address - Country:US
Practice Address - Phone:708-788-3166
Practice Address - Fax:708-788-3181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL054014818183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL4622210001Medicare ID - Type Unspecified