Provider Demographics
NPI:1518581784
Name:GARDEN FRESH PHARMACY INC.
Entity Type:Organization
Organization Name:GARDEN FRESH PHARMACY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MAJD
Authorized Official - Middle Name:AMIN
Authorized Official - Last Name:IBRAHIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-945-9058
Mailing Address - Street 1:955 W 75TH ST STE 101
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60565-1246
Mailing Address - Country:US
Mailing Address - Phone:708-945-9058
Mailing Address - Fax:
Practice Address - Street 1:955 W 75TH ST
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60565-6189
Practice Address - Country:US
Practice Address - Phone:708-945-9058
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-03
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy