Provider Demographics
NPI:1851458848
Name:MERZ APOTHECARY, INC
Entity Type:Organization
Organization Name:MERZ APOTHECARY, INC
Other - Org Name:MERZ APOTHECARY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ABDUL
Authorized Official - Middle Name:
Authorized Official - Last Name:QAIYUM
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:773-989-0900
Mailing Address - Street 1:4716 N LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-2010
Mailing Address - Country:US
Mailing Address - Phone:773-989-0900
Mailing Address - Fax:773-989-8108
Practice Address - Street 1:4716 N LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-2010
Practice Address - Country:US
Practice Address - Phone:773-989-0900
Practice Address - Fax:773-989-8108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL141790Medicare UPIN