Provider Demographics
NPI:1285404459
Name:PRISM PHARMACY BELVIDERE LTD
Entity type:Organization
Organization Name:PRISM PHARMACY BELVIDERE LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:SAMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:SHETH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-550-2215
Mailing Address - Street 1:1004 LOGAN AVE STE A
Mailing Address - Street 2:
Mailing Address - City:BELVIDERE
Mailing Address - State:IL
Mailing Address - Zip Code:61008-3955
Mailing Address - Country:US
Mailing Address - Phone:779-552-7007
Mailing Address - Fax:779-552-7009
Practice Address - Street 1:1004 LOGAN AVE STE A
Practice Address - Street 2:
Practice Address - City:BELVIDERE
Practice Address - State:IL
Practice Address - Zip Code:61008-3955
Practice Address - Country:US
Practice Address - Phone:779-552-7007
Practice Address - Fax:779-552-7009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy