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Organization
BIENESTAR PHARMACY III, INC
Active
Organization
BIENESTAR PHARMACY III, INC
Active
Other names
Bienestar Pharmacy III, Inc
Organization subpart
No
Provider details
NPI number
Authorized official
AKIL GHOGHAWALA (PRESIDENT)
(773) 924-6000
Entity
Organization
Contact information
Practice address
2359 S WESTERN AVE, SUITE 100, CHICAGO, IL 60608-3837
(773) 869-5200
(773) 869-5222
Mailing address
2359 S WESTERN AVE, SUITE 100, CHICAGO, IL 60608-3837
(773) 869-5200
(773) 869-5222
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
054020244
IL
3336C0002X
Clinic Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2168803
PK
—
Enumeration date
04/11/2017
Last updated
04/11/2017
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