Provider Demographics
NPI:1407484439
Name:YOUR PHARMACY
Entity Type:Organization
Organization Name:YOUR PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:SHEREN
Authorized Official - Middle Name:
Authorized Official - Last Name:ALSHWAIYAT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-527-2204
Mailing Address - Street 1:6019 OAKLAND AVE
Mailing Address - Street 2:
Mailing Address - City:OAK FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60452-1848
Mailing Address - Country:US
Mailing Address - Phone:708-527-2204
Mailing Address - Fax:
Practice Address - Street 1:4050 HEALTHWAY DR STE 100
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504-8184
Practice Address - Country:US
Practice Address - Phone:708-527-2204
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-27
Last Update Date:2020-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy