Provider Demographics
NPI:1215149703
Name:B & G HEINZ PHARMACY, INC
Entity type:Organization
Organization Name:B & G HEINZ PHARMACY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:FRED
Authorized Official - Middle Name:T
Authorized Official - Last Name:TRIMUEL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:773-238-8680
Mailing Address - Street 1:559 W 103RD STREET
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60628
Mailing Address - Country:US
Mailing Address - Phone:773-238-8680
Mailing Address - Fax:773-238-8634
Practice Address - Street 1:559 W 103RD STREET
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60628
Practice Address - Country:US
Practice Address - Phone:773-238-8680
Practice Address - Fax:773-238-8634
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL00540036483336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========Medicare ID - Type UnspecifiedRETAIL PHARMACY