Provider Demographics
NPI:1639114952
Name:FARMACIA LA FAMILIA
Entity Type:Organization
Organization Name:FARMACIA LA FAMILIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:LAVERY
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:773-847-0269
Mailing Address - Street 1:3824 S KEDZIE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60632-2711
Mailing Address - Country:US
Mailing Address - Phone:773-847-0269
Mailing Address - Fax:
Practice Address - Street 1:3824 S KEDZIE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60632-2711
Practice Address - Country:US
Practice Address - Phone:773-847-0269
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty