Provider Demographics
NPI:1003569823
Name:COVIFREE LAB
Entity Type:Organization
Organization Name:COVIFREE LAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ARQAM
Authorized Official - Middle Name:
Authorized Official - Last Name:HAKEEM
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:224-730-8465
Mailing Address - Street 1:2706 N HALSTED ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-1414
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2706 N HALSTED ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-1414
Practice Address - Country:US
Practice Address - Phone:224-730-8465
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-01
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory