Provider Demographics
NPI:1255491551
Name:FAMILY MEDICAL PHARMACY, INC.
Entity type:Organization
Organization Name:FAMILY MEDICAL PHARMACY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST - IN - CHARGE
Authorized Official - Prefix:MR
Authorized Official - First Name:NEHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:SALAH
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:708-598-7227
Mailing Address - Street 1:PO BOX 954
Mailing Address - Street 2:
Mailing Address - City:OAK FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60452-0954
Mailing Address - Country:US
Mailing Address - Phone:708-598-7227
Mailing Address - Fax:
Practice Address - Street 1:6815 W 95TH ST
Practice Address - Street 2:SUITE # 102
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-7000
Practice Address - Country:US
Practice Address - Phone:708-598-7227
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
IL333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL=========001Medicaid