Provider Demographics
NPI:1649270125
Name:AMERICAN PHARMACY INC
Entity type:Organization
Organization Name:AMERICAN PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:KANAIYALAL
Authorized Official - Middle Name:
Authorized Official - Last Name:VIRPARIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-343-5780
Mailing Address - Street 1:2200 W ROOSEVELT RD
Mailing Address - Street 2:
Mailing Address - City:BROADVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60155-3888
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2200 W ROOSEVELT RD
Practice Address - Street 2:
Practice Address - City:BROADVIEW
Practice Address - State:IL
Practice Address - Zip Code:60155-3888
Practice Address - Country:US
Practice Address - Phone:708-343-5730
Practice Address - Fax:708-343-2130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-27
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0002X, 332B00000X, 3336C0003X, 333600000X
IL510325723336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1463289OtherOTHER ID NUMBER
IL=========001Medicaid
1463289OtherOTHER ID NUMBER