Organization
BRIDGEPORT PHARMACY INC
Active
Other names
BRIDGEPORT PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
SNEHAL BHAVSAR (PHARMACY MANAGER)
(312) 791-9000
Entity
Organization
Contact information
Practice address
3201 S WALLACE ST, CHICAGO, IL 60616-3501
(312) 791-9000
(312) 791-9650
Mailing address
3201 S WALLACE ST, CHICAGO, IL 60616-3501
(312) 791-9000
(312) 791-9650
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
054015048
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2021465
PK
—
Enumeration date
01/04/2007
Last updated
02/10/2021
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