Provider Demographics
NPI:1184384828
Name:VISHWAM, INC
Entity type:Organization
Organization Name:VISHWAM, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PRADIP
Authorized Official - Middle Name:
Authorized Official - Last Name:VACHHANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-401-4000
Mailing Address - Street 1:963 N CONVENT ST STE E
Mailing Address - Street 2:
Mailing Address - City:BOURBONNAIS
Mailing Address - State:IL
Mailing Address - Zip Code:60914-1386
Mailing Address - Country:US
Mailing Address - Phone:815-401-4000
Mailing Address - Fax:815-855-8550
Practice Address - Street 1:963 N CONVENT ST STE E
Practice Address - Street 2:
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914-1386
Practice Address - Country:US
Practice Address - Phone:815-401-4000
Practice Address - Fax:815-855-8550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-21
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy