Provider Demographics
NPI:1720629504
Name:LAYTON PHARMACY SC
Entity Type:Organization
Organization Name:LAYTON PHARMACY SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DHARMESH
Authorized Official - Middle Name:
Authorized Official - Last Name:GHELANI
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:414-800-4070
Mailing Address - Street 1:2741 W LAYTON AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53221-2600
Mailing Address - Country:US
Mailing Address - Phone:414-800-4070
Mailing Address - Fax:414-800-4068
Practice Address - Street 1:2741 W LAYTON AVE STE 105
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53221-2600
Practice Address - Country:US
Practice Address - Phone:414-800-4070
Practice Address - Fax:414-800-4068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-03
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI9607-42OtherSTATE LIC