Provider Demographics
NPI:1063623908
Name:PHARMACIA EL AMANECER, INC
Entity type:Organization
Organization Name:PHARMACIA EL AMANECER, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KISHORE
Authorized Official - Middle Name:B
Authorized Official - Last Name:PUROHIT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-850-9686
Mailing Address - Street 1:1842 S BLUE ISLAND AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60608-3013
Mailing Address - Country:US
Mailing Address - Phone:312-850-9686
Mailing Address - Fax:312-850-9697
Practice Address - Street 1:1842 S BLUE ISLAND AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-3013
Practice Address - Country:US
Practice Address - Phone:312-850-9686
Practice Address - Fax:312-850-9697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy