Organization
PROVENA PHARMACY ELGIN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SATYA RAO RPH (DIR OF PHCY)
(847) 695-3200
Entity
Organization
Contact information
Practice address
750 FLETCHER DR, STE 103, ELGIN, IL 60123-4703
(847) 931-5535
(849) 622-2072
Mailing address
750 FLETCHER DR, STE 103, ELGIN, IL 60123-4703
Taxonomy
Speciality
Code
Description
License number
State
3336C0002X
Clinic Pharmacy
54013758
IL
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1460803
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
07/30/2006
Last updated
09/11/2025
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