Healthcare Provider Details

I. General information

NPI: 1578737409
Provider Name (Legal Business Name): 87TH & HARLEM CRESCENT PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2008
Last Update Date: 07/11/2024
Certification Date: 07/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7261 W 87TH ST
BRIDGEVIEW IL
60455-1821
US

IV. Provider business mailing address

7261 W 87TH ST
BRIDGEVIEW IL
60455-1821
US

V. Phone/Fax

Practice location:
  • Phone: 708-598-0505
  • Fax: 708-598-0606
Mailing address:
  • Phone: 708-598-0505
  • Fax: 708-598-0606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number054016428
License Number StateIL

VIII. Authorized Official

Name: MUHAMMAD TAHA
Title or Position: PIC
Credential:
Phone: 708-598-0505