1326144460 NPI number — ORLAND HILLS PHARMACY, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326144460 NPI number — ORLAND HILLS PHARMACY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ORLAND HILLS 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:
HILLS DRUG ORLAND
Provider Other Organization Name Type Code:
3
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:
1326144460
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/24/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15300 WEST AVE
Provider Second Line Business Mailing Address:
SUITE 123
Provider Business Mailing Address City Name:
ORLAND PARK
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60462
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-226-9840
Provider Business Mailing Address Fax Number:
708-226-9843

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15300 WEST AVE
Provider Second Line Business Practice Location Address:
SUITE 123
Provider Business Practice Location Address City Name:
ORLAND PARK
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60462
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-226-9840
Provider Business Practice Location Address Fax Number:
708-226-9843
Provider Enumeration Date:
09/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GUASTELLA
Authorized Official First Name:
PHILIP
Authorized Official Middle Name:
L
Authorized Official Title or Position:
PRESIDENT/OWNER
Authorized Official Telephone Number:
708-226-9840

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  54015253 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1477074 . This is a "NABP NO" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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