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Organization
AVICENNA PHARMACY INC
Active
Organization
AVICENNA PHARMACY INC
Active
Other names
Avicenna Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
AHMED MAHAFZAH RPH (OWNER, PIC, AO)
(708) 529-7222
Entity
Organization
Contact information
Practice address
10837 S CICERO AVE STE 110C, OAK LAWN, IL 60453-6459
(708) 529-7222
(708) 529-7325
Mailing address
10604 SOUTHWEST HWY STE 102, CHICAGO RIDGE, IL 60415-2704
(708) 930-5393
(708) 529-3593
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
NULL
3336C0003X
Community/Retail Pharmacy
Primary
054017745
IL
3336C0004X
Compounding Pharmacy
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2133562
PK
—
Enumeration date
01/23/2012
Last updated
08/30/2023
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