Provider Demographics
NPI:1558072751
Name:FIVE STAR PHARMACY LLC
Entity Type:Organization
Organization Name:FIVE STAR PHARMACY LLC
Other - Org Name:FIVE STAR PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:AL-HADIDI
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:708-843-1517
Mailing Address - Street 1:4950 N CUMBERLAND AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:NORRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60706-2902
Mailing Address - Country:US
Mailing Address - Phone:708-843-1517
Mailing Address - Fax:
Practice Address - Street 1:4950 N CUMBERLAND AVE STE 1
Practice Address - Street 2:
Practice Address - City:NORRIDGE
Practice Address - State:IL
Practice Address - Zip Code:60706-2902
Practice Address - Country:US
Practice Address - Phone:708-843-1517
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:5 STAR PHARMACY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-12-08
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy