Provider Demographics
NPI:1356700744
Name:OAK LAWN HEALTH MART PHARMACY INC
Entity type:Organization
Organization Name:OAK LAWN HEALTH MART PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER, PIC, AO
Authorized Official - Prefix:
Authorized Official - First Name:HADIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALHALABI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:708-443-4310
Mailing Address - Street 1:4700 W 95TH ST STE 101
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-2538
Mailing Address - Country:US
Mailing Address - Phone:708-443-4310
Mailing Address - Fax:708-443-4311
Practice Address - Street 1:4700 W 95TH ST STE 101
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2538
Practice Address - Country:US
Practice Address - Phone:708-443-4310
Practice Address - Fax:708-443-4311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-15
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
291U00000X, 332B00000X, 333600000X
IL054.0196763336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No291U00000XLaboratoriesClinical Medical Laboratory
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2158127OtherPK
2158127OtherPK