# LIFE SOURCE PHARMACY INC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** Life Source Pharmacy, Inc
- **Organization subpart:** No

## Provider details

- **NPI number:** 1821316647
- **Authorized official:** PRASHANT PATEL (PRESIDENT)
- **Authorized official phone:** (773) 321-2656

## Contact information

- **Practice address:** 11238 S WESTERN AVE, CHICAGO, IL 60643-4116
- **Practice address phone:** (773) 321-2656
- **Practice address fax:** (773) 941-4294
- **Mailing address:** 5 OSPREY CT, STREAMWOOD, IL 60107-2813
- **Mailing address phone:** (773) 321-2656

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 054-017353 | IL | Yes |

## Other

- **Enumeration date:** 05/05/2010
- **Last updated:** 03/22/2015

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2124980 | PK | — |