Organization
OM JAY GAYATRI MA INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GHANSHYAM PATEL (IN CHARGE OWNER)
(773) 768-7868
Entity
Organization
Contact information
Practice address
2315 E 93RD ST, STE 215, CHICAGO, IL 60617-3936
(773) 768-7868
(773) 768-7869
Mailing address
2315 E 93RD ST, STE 215, CHICAGO, IL 60617-3936
(773) 768-7868
(773) 768-7869
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0002X
Clinic Pharmacy
Primary
054014973
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2021364
PK
—
Enumeration date
08/31/2006
Last updated
04/30/2018
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