NPIMap

Organization Active NPI

Life Source Pharmacy Inc

  • Community/Retail Pharmacy
  • Chicago, IL
National Provider Identifier
1821316647
Registry record updated Mar 22, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
054-017353 Issued in IL
Legal business name
LIFE SOURCE PHARMACY INC
Doing business as
Life Source Pharmacy, Inc
Practice address
11238 S Western Ave
Chicago, IL 60643-4116
Phone
(773) 321-2656
Fax
(773) 941-4294
NPI assigned
May 5, 2010
Last updated
Mar 22, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 22, 2015

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

Authorized official

Name
Prashant Patel
Title
President
Phone
(773) 321-2656

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X NU
Pharmacy 333600000X NU
Community/Retail Pharmacy 3336C0003X 054-017353 IL Primary

Addresses

Primary practice location

11238 S Western Ave
Chicago, IL 60643-4116

Mailing address

5 Osprey CT
Streamwood, IL 60107-2813
Phone (773) 321-2656

Other identifiers 1

IdentifierTypeStateIssuer
2124980OtherPK

Other names 1

  • Life Source Pharmacy, Inc Doing business as

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1273017600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1426982400000",
    "number": "1821316647",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5 OSPREY CT",
            "city": "STREAMWOOD",
            "state": "IL",
            "postal_code": "601072813",
            "telephone_number": "773-321-2656"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11238 S WESTERN AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606434116",
            "telephone_number": "773-321-2656",
            "fax_number": "773-941-4294"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFE SOURCE PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-05-05",
        "last_updated": "2015-03-22",
        "status": "A",
        "authorized_official_last_name": "PATEL",
        "authorized_official_first_name": "PRASHANT",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "773-321-2656"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "IL",
            "license": "054-017353",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2124980",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Life Source Pharmacy, Inc",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.