Organization
AVICENNA PHARMACY INC
Active
Other names
Avicenna Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
AHMED MAHAFZAH RPH (OWNER, PIC, AO)
(708) 529-7222
Entity
Organization
Contact information
Practice address
10837 S CICERO AVE STE 110C, OAK LAWN, IL 60453-6459
(708) 529-7222
(708) 529-7325
Mailing address
10604 SOUTHWEST HWY STE 102, CHICAGO RIDGE, IL 60415-2704
(708) 930-5393
(708) 529-3593
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
054017745
IL
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2133562
PK
—
Enumeration date
01/23/2012
Last updated
08/30/2023
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