Healthcare Provider Details

I. General information

NPI: 1366582421
Provider Name (Legal Business Name): FARMACIA DE LAWNDALE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 05/08/2025
Certification Date: 05/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2621 S LAWNDALE AVE
CHICAGO IL
60623-4520
US

IV. Provider business mailing address

2621 S LAWNDALE AVE
CHICAGO IL
60623-4520
US

V. Phone/Fax

Practice location:
  • Phone: 773-542-9595
  • Fax: 773-542-9590
Mailing address:
  • Phone: 773-542-9595
  • Fax: 773-542-9590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051034198
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. AMY SHAH
Title or Position: PHARMACIST-IN-CHARGE
Credential: PHARMD
Phone: 773-542-9595