# AVICENNA PHARMACY INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Avicenna Pharmacy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1437420460
- **Authorized official:** AHMED MAHAFZAH RPH (OWNER, PIC, AO)
- **Authorized official phone:** (708) 529-7222

## Contact information

- **Practice address:** 10837 S CICERO AVE STE 110C, OAK LAWN, IL 60453-6459
- **Practice address phone:** (708) 529-7222
- **Practice address fax:** (708) 529-7325
- **Mailing address:** 10604 SOUTHWEST HWY STE 102, CHICAGO RIDGE, IL 60415-2704
- **Mailing address phone:** (708) 930-5393
- **Mailing address fax:** (708) 529-3593

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 054017745 | IL | Yes |
| 3336C0004X | Compounding Pharmacy | — | NULL | — |

## Other

- **Enumeration date:** 01/23/2012
- **Last updated:** 08/30/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2133562 | PK | — |