Healthcare Provider Details

I. General information

NPI: 1235666835
Provider Name (Legal Business Name): EPHRAIM PHARMACY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2215 W 95TH ST
CHICAGO IL
60643
US

IV. Provider business mailing address

2215 W 95TH ST
CHICAGO IL
60643-1001
US

V. Phone/Fax

Practice location:
  • Phone: 773-454-3392
  • Fax:
Mailing address:
  • Phone: 773-454-3392
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: GORDON EGBUNA
Title or Position: SECRETARY
Credential:
Phone: 773-454-3392