Provider Demographics
NPI:1124547849
Name:LUNA PHARMACY II LLC
Entity Type:Organization
Organization Name:LUNA PHARMACY II LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AIMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ALANFOUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-340-4445
Mailing Address - Street 1:5352 N LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-2316
Mailing Address - Country:US
Mailing Address - Phone:773-340-4445
Mailing Address - Fax:773-340-4446
Practice Address - Street 1:235 W 95TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60628-1321
Practice Address - Country:US
Practice Address - Phone:773-340-4445
Practice Address - Fax:773-340-4446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-13
Last Update Date:2017-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0540203363336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy