# HALSTED & 79TH ST. PHARMACY INC.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Broadway Ave Pharmacy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1861551079
- **Authorized official:** TUSHAR MEHTA RPH (PHARMACY MANAGER)
- **Authorized official phone:** (708) 450-0400

## Contact information

- **Practice address:** 151 BROADWAY ST, MELROSE PARK, IL 60160-3702
- **Practice address phone:** (708) 450-0400
- **Practice address fax:** (708) 344-3668
- **Mailing address:** 151 BROADWAY AVE, MELROSE PARK, IL 60160-3702
- **Mailing address phone:** (708) 450-0400
- **Mailing address fax:** (708) 344-3668

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | 054014924 | IL | Yes |

## Other

- **Enumeration date:** 12/06/2006
- **Last updated:** 02/03/2011