Organization
BROADWAY PHARMACY INC
Active
Other names
BROADWAY PHARMACY INC
Organization subpart
No
Provider details
NPI number
Authorized official
JAYPRAKASH PANDYA (PRESIDENT PHARMACIST)
(773) 271-9727
Entity
Organization
Contact information
Practice address
4564 N BROADWAY ST, CHICAGO, IL 60640-5602
(773) 271-9727
(773) 271-8306
Mailing address
4564 N BROADWAY ST, CHICAGO, IL 60640-5602
(773) 271-9727
(773) 271-8306
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
054013828
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2021693
PK
—
Enumeration date
02/14/2007
Last updated
05/14/2014
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