# PILL SHOP PHARMACY INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Pill Shop Pharmacy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1588906507
- **Authorized official:** ANTOINE MOURANI (DIRECTOR)
- **Authorized official phone:** (312) 659-3588

## Contact information

- **Practice address:** 3535 E NEW YORK ST STE 117, AURORA, IL 60504-4466
- **Practice address phone:** (630) 618-2048
- **Practice address fax:** (630) 618-2394
- **Mailing address:** 3535 E NEW YORK ST STE 117, AURORA, IL 60504-4466
- **Mailing address phone:** (630) 618-2048
- **Mailing address fax:** (630) 618-2394

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 054.018224 | IL | Yes |
| 3336C0004X | Compounding Pharmacy | — | NULL | — |

## Other

- **Enumeration date:** 03/18/2013
- **Last updated:** 05/18/2015

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1487873001 | — | IL |
| 01 | — | 2139415 | PK | — |