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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