Organization
KORLE BU PHARMACY LLC
Active
Other names
KORLE BU PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
PRASHANT PATEL PHARM D (PHARMICIST IN CHARGE)
(847) 858-4776
Entity
Organization
Contact information
Practice address
5517 S MICHIGAN AVE, CHICAGO, IL 60637-1012
(773) 321-2656
(773) 667-9815
Mailing address
5 OSPREY CT, STREAMWOOD, IL 60107-2813
Taxonomy
Speciality
Code
Description
License number
State
3336C0002X
Clinic Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
54016112
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1480350
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
02/02/2007
Last updated
03/24/2010
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