Provider Demographics
NPI:1902964422
Name:GALEN PHARMACY INC.
Entity Type:Organization
Organization Name:GALEN PHARMACY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:R
Authorized Official - Last Name:WAX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-675-7170
Mailing Address - Street 1:3926 W TOUHY AVE
Mailing Address - Street 2:
Mailing Address - City:LINCOLNWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60712-1028
Mailing Address - Country:US
Mailing Address - Phone:847-675-7170
Mailing Address - Fax:847-675-5106
Practice Address - Street 1:3926 W TOUHY AVE
Practice Address - Street 2:
Practice Address - City:LINCOLNWOOD
Practice Address - State:IL
Practice Address - Zip Code:60712-1028
Practice Address - Country:US
Practice Address - Phone:847-675-7170
Practice Address - Fax:847-675-5106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========0001Medicaid
IL4841680001Medicare ID - Type Unspecified