Organization
MONA KEA PHARMACY, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PRASHANT PATEL PHARM.D. (PRESIDENT)
(847) 858-4776
Entity
Organization
Contact information
Practice address
501 THORNHILL DR, SUITE B, CAROL STREAM, IL 60188-2793
(630) 580-9462
Mailing address
501 THORNHILL DR, SUITE B, CAROL STREAM, IL 60188-2793
(630) 580-9462
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
054-17758
IL
332BX2000X
Oxygen Equipment & Supplies (DME)
054-17758
IL
333600000X
Pharmacy
Primary
054-17758
IN
3336C0003X
Community/Retail Pharmacy
054-17758
IL
3336C0004X
Compounding Pharmacy
054-17758
IL
3336S0011X
Specialty Pharmacy
054-17758
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
054-17758
IL DEPT OF FINANCIAL AND PROFESSIONAL REGULATION
IL
Enumeration date
09/22/2011
Last updated
09/22/2011
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