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Organization
OLYMPIA FIELDS PHARMACY INC
Active
Organization
OLYMPIA FIELDS PHARMACY INC
Active
Other names
BIENESTAR PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
AKIL GHOGAWALA PHARM.D. (PHCY MGR)
(847) 420-3789
Entity
Organization
Contact information
Practice address
966 W 21ST ST, CHICAGO, IL 60608-4511
(312) 226-2266
(312) 226-9766
Mailing address
966 W 21ST ST, STE 104, CHICAGO, IL 60608-4511
(312) 226-2266
(312) 226-9766
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
NULL
333600000X
Pharmacy
—
NULL
3336C0002X
Clinic Pharmacy
—
NULL
3336C0003X
Community/Retail Pharmacy
Primary
054015813
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2023192
PK
—
Enumeration date
08/18/2006
Last updated
02/21/2017
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