Provider Demographics
NPI:1265447858
Name:A & D FAMILY MEDICAL CENTER PHARMACY INC
Entity type:Organization
Organization Name:A & D FAMILY MEDICAL CENTER PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KISHORKANT
Authorized Official - Middle Name:
Authorized Official - Last Name:CHIKANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-826-1719
Mailing Address - Street 1:8352 N NEWLAND AVE
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714-2642
Mailing Address - Country:US
Mailing Address - Phone:773-826-1719
Mailing Address - Fax:773-533-1622
Practice Address - Street 1:732 S PULASKI RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60624-4058
Practice Address - Country:US
Practice Address - Phone:773-826-1719
Practice Address - Fax:773-533-1622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0540088313336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2018624OtherPK
2018624OtherPK