Halsted & 79TH St. Pharmacy Inc.

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

054014924 Issued in IL

Legal business name

HALSTED & 79TH ST. PHARMACY INC.

Practice address

151 Broadway St
Melrose Park, IL 60160-3702

Phone

(708) 450-0400

Fax

(708) 344-3668

NPI assigned

Dec 6, 2006

Organization subpart

No

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

Authorized official

Name

Tushar Mehta, RPHNPI 1326008343

Title

Pharmacy Manager

Phone

(708) 450-0400

Specialties & licenses 1

Addresses

Other names 1

• Broadway Ave Pharmacy Doing business as

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Tushar M Mehta

  • Pharmacist
  • Oak Brook, IL
  • NPI 1326008343
  NPD Authorized official
• Priti Parekh, PHARM.D.

  • Pharmacist
  • Melrose Park, IL
  • NPI 1811930480
  NPD (past)
• Aneesh Sawlani

  • Pharmacist
  • Melrose Park, IL
  • NPI 1235712738
  NPD (past)
• Amar Jayesh Shah, PHARMD

  • Pharmacist
  • Addison, IL
  • NPI 1275166894
  NPD (past)
• Suhani Shail Shah

  • Pharmacist
  • Melrose Park, IL
  • NPI 1003320318
  NPD (past)

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

{
    "created_epoch": "1165363200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1296691200000",
    "number": "1861551079",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "151 BROADWAY AVE",
            "city": "MELROSE PARK",
            "state": "IL",
            "postal_code": "601603702",
            "telephone_number": "708-450-0400",
            "fax_number": "708-344-3668"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "151 BROADWAY ST",
            "city": "MELROSE PARK",
            "state": "IL",
            "postal_code": "601603702",
            "telephone_number": "708-450-0400",
            "fax_number": "708-344-3668"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HALSTED & 79TH ST. PHARMACY INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-06",
        "last_updated": "2011-02-03",
        "status": "A",
        "authorized_official_last_name": "MEHTA",
        "authorized_official_first_name": "TUSHAR",
        "authorized_official_title_or_position": "PHARMACY MANAGER",
        "authorized_official_telephone_number": "708-450-0400",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "IL",
            "license": "054014924",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Broadway Ave Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Denise Guerrero
• Qian Guo, M.D
• Dawn R Hackel, DPM
• Hai Solomon M.D.S.C.
• Shaniquia Hall, MHP
• Hands and Heart Home Health, Inc
• Judyta Joanna Hankus, PT, DPT
• Harmony Care Home Services, Inc.
• Richard Gerald Harris, M.D.
• Rebecca Harty, APN-BC

• Community/Retail Pharmacy in Melrose Park, IL
• Providers in Melrose Park, IL by specialty
• Community/Retail Pharmacy in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2011; 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.