Provider Demographics
NPI:1649521667
Name:GREAT HEALTH PHARMACY INC
Entity type:Organization
Organization Name:GREAT HEALTH PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:BERENICE
Authorized Official - Last Name:TORRES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-503-1823
Mailing Address - Street 1:6422 W BELMONT AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60634-3921
Mailing Address - Country:US
Mailing Address - Phone:773-887-4497
Mailing Address - Fax:773-417-4184
Practice Address - Street 1:6422 W BELMONT AVE STE 101
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634-3921
Practice Address - Country:US
Practice Address - Phone:773-887-4497
Practice Address - Fax:773-417-4184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-01
Last Update Date:2018-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL054-018001333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy