NPIMap

Organization Active NPI

Addison Pharmacy, Inc

Doing business as Westchester Pharmacy

  • Community/Retail Pharmacy
  • Bellwood, IL
National Provider Identifier
1104217389
Registry record updated Feb 9, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
ADDISON PHARMACY, INC
Doing business as
Westchester Pharmacy
Practice address
4009 Warren Ave Ste 100
Bellwood, IL 60104-2066
Phone
(708) 897-2424
Fax
(708) 897-2426
NPI assigned
Feb 10, 2015
Last updated
Feb 9, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 9, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Kerul Mehta, RPH.
Title
Owner
Phone
(630) 543-0988

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X Primary

Addresses

Primary practice location

4009 Warren Ave Ste 100
Bellwood, IL 60104-2066

Mailing address

4009 Warren Ave Ste 100
Bellwood, IL 60104-2066
Phone (708) 897-2424

Other names 1

  • Westchester Pharmacy Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130530000219 IL Part B Supplier - Mass Immunization (Roster Biller Only) 2668687237 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Addison, IL; Bellwood, IL

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Addison Pharmacy Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

414 W Lake St
Addison, IL 60101
Phone (630) 543-0988

4009 Warren Ave
Ste 100
Bellwood, IL 60104
Phone (708) 897-2424

947 S Mannheim Rd
Westchester, IL 60154
Phone (708) 343-1300

Practitioners & affiliated clinicians

Practitioners 18

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 18

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1423526400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1612828800000",
    "number": "1104217389",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4009 WARREN AVE STE 100",
            "city": "BELLWOOD",
            "state": "IL",
            "postal_code": "601042066",
            "telephone_number": "708-897-2424",
            "fax_number": "708-897-2426"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4009 WARREN AVE STE 100",
            "city": "BELLWOOD",
            "state": "IL",
            "postal_code": "601042066",
            "telephone_number": "708-897-2424",
            "fax_number": "708-897-2426"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADDISON PHARMACY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-02-10",
        "last_updated": "2021-02-09",
        "certification_date": "2021-02-09",
        "status": "A",
        "authorized_official_last_name": "MEHTA",
        "authorized_official_first_name": "KERUL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "630-543-0988",
        "authorized_official_credential": "RPH."
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Westchester Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Westchester Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bellwood, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.