# LUNA PHARMACY AT SOUTH SHORE LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1053888990
- **Authorized official:** MOHAMMAD KHAMIS (PRESIDENT)
- **Authorized official phone:** (773) 353-5047

## Contact information

- **Practice address:** 1952 E 73RD ST, CHICAGO, IL 60649-2902
- **Practice address phone:** (773) 493-4444
- **Mailing address:** 5352 N LINCOLN AVE, CHICAGO, IL 60625-2316

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | — | NULL | Yes |

## Other

- **Enumeration date:** 10/29/2018
- **Last updated:** 10/29/2018