Provider Demographics
NPI:1689163503
Name:MILLENIUM PHARMACY LTD
Entity Type:Organization
Organization Name:MILLENIUM PHARMACY LTD
Other - Org Name:MILLENNIUM PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST IN CHARGE/OWBER
Authorized Official - Prefix:MR
Authorized Official - First Name:AHMED
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHAFZAH
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:708-930-5393
Mailing Address - Street 1:10604 SOUTHWEST HWY STE 102
Mailing Address - Street 2:
Mailing Address - City:CHICAGO RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60415-2704
Mailing Address - Country:US
Mailing Address - Phone:708-930-5393
Mailing Address - Fax:708-529-3593
Practice Address - Street 1:10604 SOUTHWEST HIGHWAY
Practice Address - Street 2:SUITE 102
Practice Address - City:CHICAGO RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60415
Practice Address - Country:US
Practice Address - Phone:708-930-5393
Practice Address - Fax:708-529-3593
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-07
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy