Provider Demographics
NPI:1447441134
Name:OAKMILL PHARMACY, LLC
Entity type:Organization
Organization Name:OAKMILL PHARMACY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:JIGAR
Authorized Official - Middle Name:V
Authorized Official - Last Name:DESAI
Authorized Official - Suffix:
Authorized Official - Credentials:BACHOLOR SCIENCE
Authorized Official - Phone:847-518-0750
Mailing Address - Street 1:8118 N. MILWAUKEE AVE SUITE-104
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714-2817
Mailing Address - Country:US
Mailing Address - Phone:847-518-0750
Mailing Address - Fax:847-518-0427
Practice Address - Street 1:8118 N. MILWAUKEE AVE SUITE-104
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714-2817
Practice Address - Country:US
Practice Address - Phone:847-518-0750
Practice Address - Fax:847-518-0427
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-07
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL054-16197333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1481100OtherNABP (NCPDP)
IL=========001Medicaid
IL1481100OtherNABP (NCPDP)