1003555251 NPI number — SILVER PHARMACY, INC.

Table of content: (NPI 1003555251)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003555251 NPI number — SILVER PHARMACY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SILVER PHARMACY, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003555251
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/18/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2045 W GRAND AVE STE B #94702
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60612
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
815-800-3100
Provider Business Mailing Address Fax Number:
815-800-3200

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1890 SILVER CROSS BLVD STE 120
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW LENOX
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60451-9528
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-800-3100
Provider Business Practice Location Address Fax Number:
815-800-3200
Provider Enumeration Date:
06/03/2022

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ALAHMED
Authorized Official First Name:
NOURA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
815-800-3100

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 054022332 . This is a "STATE BOARD OF PHARMACY LICENSE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".