Organization
HALSTED & 79TH ST. PHARMACY INC.
Active
Other names
Broadway Ave Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
TUSHAR MEHTA RPH (PHARMACY MANAGER)
(708) 450-0400
Entity
Organization
Contact information
Practice address
151 BROADWAY ST, MELROSE PARK, IL 60160-3702
(708) 450-0400
(708) 344-3668
Mailing address
151 BROADWAY AVE, MELROSE PARK, IL 60160-3702
(708) 450-0400
(708) 344-3668
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
054014924
IL
Other
Enumeration date
12/06/2006
Last updated
02/03/2011
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