Provider Demographics
NPI:1972928166
Name:BIENESTAR PHARMACY II INC
Entity Type:Organization
Organization Name:BIENESTAR PHARMACY II INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:AKIL
Authorized Official - Middle Name:
Authorized Official - Last Name:GHOGHAWALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-956-7786
Mailing Address - Street 1:6447 CERMAK RD
Mailing Address - Street 2:
Mailing Address - City:BERWYN
Mailing Address - State:IL
Mailing Address - Zip Code:60402-2311
Mailing Address - Country:US
Mailing Address - Phone:708-956-7786
Mailing Address - Fax:
Practice Address - Street 1:6447 CERMAK RD
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402-2311
Practice Address - Country:US
Practice Address - Phone:708-956-7786
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-25
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid