Organization
PRIME PLUS LAKEVIEW LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMRO ATASSI (MANAGER)
(773) 568-8340
Entity
Organization
Contact information
Practice address
3156 N CLARK ST, CHICAGO, IL 60657
(773) 568-8340
(773) 568-8341
Mailing address
3156 N CLARK ST, CHICAGO, IL 60657
(773) 568-8340
(773) 568-8341
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
054005995
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1431523
NABP/NCPDP
IL
05
—
=========
—
IL
Enumeration date
08/28/2006
Last updated
11/09/2021
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