Provider Demographics
NPI:1376504829
Name:ELGIN CENTER PHARMACY INC
Entity type:Organization
Organization Name:ELGIN CENTER PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:ARVIND
Authorized Official - Middle Name:
Authorized Official - Last Name:SURTI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:847-488-9273
Mailing Address - Street 1:901 CENTER ST
Mailing Address - Street 2:STE 200
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60120-2104
Mailing Address - Country:US
Mailing Address - Phone:847-697-1600
Mailing Address - Fax:847-697-1612
Practice Address - Street 1:901 CENTER ST
Practice Address - Street 2:STE 200
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60120-2104
Practice Address - Country:US
Practice Address - Phone:847-697-1600
Practice Address - Fax:847-697-1612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-31
Last Update Date:2014-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
IL0540157873336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2021907OtherPK
2021907OtherPK
IL=========001Medicaid