Organization
RAVENSWOOD PHARMACY INC
Active
Other names
Ravenswood Pharmacy INC.
Organization subpart
No
Provider details
NPI number
Authorized official
SAMEH ATTIA (PIC)
(773) 612-2517
Entity
Organization
Contact information
Practice address
1945 W WILSON AVE STE 102, CHICAGO, IL 60640-5255
(773) 561-8048
(773) 561-8084
Mailing address
1945 W WILSON AVE STE 102, CHICAGO, IL 60640-5255
(773) 561-8048
(773) 561-8084
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
054017816
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1486302
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
12/08/2011
Last updated
03/16/2012
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