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
—
—
333600000X
Pharmacy
—
—
3336C0002X
Clinic Pharmacy
—
—
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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