Provider Demographics
NPI:1982212635
Name:GRAND PHARMACY LLC
Entity Type:Organization
Organization Name:GRAND PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BEHROUZ
Authorized Official - Middle Name:
Authorized Official - Last Name:HOGHOUGHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-622-2156
Mailing Address - Street 1:229 W GRAND AVE STE F
Mailing Address - Street 2:
Mailing Address - City:BENSENVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60106-3365
Mailing Address - Country:US
Mailing Address - Phone:630-422-3162
Mailing Address - Fax:630-422-1927
Practice Address - Street 1:229 W GRAND AVE STE F
Practice Address - Street 2:
Practice Address - City:BENSENVILLE
Practice Address - State:IL
Practice Address - Zip Code:60106-3365
Practice Address - Country:US
Practice Address - Phone:630-422-3162
Practice Address - Fax:630-422-1927
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-20
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy