Provider Demographics
NPI:1124270228
Name:HOME MEDICAL SUPPLIES AND PHARMACY
Entity type:Organization
Organization Name:HOME MEDICAL SUPPLIES AND PHARMACY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JIGNESH
Authorized Official - Middle Name:
Authorized Official - Last Name:GANDHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-660-1709
Mailing Address - Street 1:711 DEVON AVE
Mailing Address - Street 2:203
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-4713
Mailing Address - Country:US
Mailing Address - Phone:847-292-9984
Mailing Address - Fax:847-292-9986
Practice Address - Street 1:711 DEVON AVE
Practice Address - Street 2:203
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-4713
Practice Address - Country:US
Practice Address - Phone:847-292-9984
Practice Address - Fax:847-292-9986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-21
Last Update Date:2009-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL054-165373336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1482568OtherNCPDP PROVIDER IDENTIFICATION NUMBER