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Organization
EDISON MEDICAL PHARMACY INC
Active
Organization
EDISON MEDICAL PHARMACY INC
Active
Other names
EDISON MEDICAL PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
PRAVINCHANDRA SHAH RPH (RPHOWNER)
(773) 533-2535
Entity
Organization
Contact information
Practice address
4240 W MADISON ST, CHICAGO, IL 60624-2288
(773) 533-2535
(773) 533-2535
Mailing address
4240 W MADISON ST, CHICAGO, IL 60624-2288
(773) 533-2535
(773) 533-2535
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
NULL
3336C0003X
Community/Retail Pharmacy
Primary
054009337
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2020547
PK
—
Enumeration date
12/04/2006
Last updated
03/13/2015
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