Organization
EDISON MEDICAL PHARMACY INC
Active
Other names
EDISON MEDICAL PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
PRAVINCHANDRA SHAH RPH (RPHOWNER)
(773) 533-2535
Entity
Organization
Contact information
Practice address
4240 W MADISON ST, CHICAGO, IL 60624-2288
(773) 533-2535
(773) 533-2535
Mailing address
4240 W MADISON ST, CHICAGO, IL 60624-2288
(773) 533-2535
(773) 533-2535
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
054009337
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2020547
PK
—
Enumeration date
12/04/2006
Last updated
03/13/2015
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