Healthcare Provider Details

I. General information

NPI: 1700335734
Provider Name (Legal Business Name): SHEEFA PHARMACY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2016
Last Update Date: 09/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8519 S HARLEM AVENUE
BURBANK IL
60459
US

IV. Provider business mailing address

8519 S HARLEM AVENUE
BURBANK IL
60459
US

V. Phone/Fax

Practice location:
  • Phone: 708-298-8222
  • Fax: 708-298-6983
Mailing address:
  • Phone: 708-298-8222
  • Fax: 708-298-6983

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number054.020003
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JEREMY KLEIN
Title or Position: OWNER
Credential:
Phone: 561-699-0908