# OLYMPIA FIELDS PHARMACY INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** BIENESTAR PHARMACY
- **Organization subpart:** No

## Provider details

- **NPI number:** 1104930098
- **Authorized official:** AKIL GHOGAWALA PHARM.D. (PHCY MGR)
- **Authorized official phone:** (847) 420-3789

## Contact information

- **Practice address:** 966 W 21ST ST, CHICAGO, IL 60608-4511
- **Practice address phone:** (312) 226-2266
- **Practice address fax:** (312) 226-9766
- **Mailing address:** 966 W 21ST ST, STE 104, CHICAGO, IL 60608-4511
- **Mailing address phone:** (312) 226-2266
- **Mailing address fax:** (312) 226-9766

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0002X | Clinic Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 054015813 | IL | Yes |

## Other

- **Enumeration date:** 08/18/2006
- **Last updated:** 02/21/2017

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2023192 | PK | — |