Provider Demographics
NPI:1831516970
Name:MIDWEST PHARMACY SERVICES LLC
Entity type:Organization
Organization Name:MIDWEST PHARMACY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SHAREHOLDER
Authorized Official - Prefix:MR
Authorized Official - First Name:TILAK
Authorized Official - Middle Name:
Authorized Official - Last Name:MARWAHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-275-3769
Mailing Address - Street 1:5470 W MADISON ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60644-4031
Mailing Address - Country:US
Mailing Address - Phone:773-379-7773
Mailing Address - Fax:773-379-1020
Practice Address - Street 1:5470 W MADISON ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60644-4031
Practice Address - Country:US
Practice Address - Phone:773-379-7773
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-26
Last Update Date:2015-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy