Provider Demographics
NPI:1184153157
Name:OAK STREET PHARMACY
Entity type:Organization
Organization Name:OAK STREET PHARMACY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:HANI
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDALLAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:872-215-7111
Mailing Address - Street 1:2850 W 95TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60805-2703
Mailing Address - Country:US
Mailing Address - Phone:708-423-4700
Mailing Address - Fax:708-423-4720
Practice Address - Street 1:2850 W 95TH ST STE 100
Practice Address - Street 2:
Practice Address - City:EVERGREEN PARK
Practice Address - State:IL
Practice Address - Zip Code:60805-2703
Practice Address - Country:US
Practice Address - Phone:708-423-4700
Practice Address - Fax:708-423-4720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-05
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL054020267OtherILLINOIS PHARMACY LICENSE