Organization
MAYWOOD COMMUNITY PHARMACY LLC
Active
Other names
maywood community pharmacy. llc
Organization subpart
No
Provider details
NPI number
Authorized official
JITESH PATEL (PHARMACIST)
(630) 999-5298
Entity
Organization
Contact information
Practice address
1411 S 5TH AVE, MAYWOOD, IL 60153-2128
(708) 345-4658
Mailing address
1411 S 5TH AVE, MAYWOOD, IL 60153-2128
(708) 345-4658
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
054016702
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1483851
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
09/21/2009
Last updated
11/04/2009
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