| NPI | 1861551079 |
|---|---|
| Doing Business As | BROADWAY AVE PHARMACY |
| Entity Type | Organization |
| Authorized Contact | TUSHAR MEHTA Pharmacy Manager 708-450-0400 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: IL 054014924) |
| Enumeration Date | 2006-12-06 |
| Last Update Date | 2011-02-03 |