Healthcare Provider Details

I. General information

NPI: 1255981106
Provider Name (Legal Business Name): ELSDON PHARMACY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2019
Last Update Date: 09/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4254 W 55TH ST STE 100
CHICAGO IL
60632-4642
US

IV. Provider business mailing address

4254 W 55TH ST STE 100
CHICAGO IL
60632-4642
US

V. Phone/Fax

Practice location:
  • Phone: 773-582-2660
  • Fax: 773-767-3022
Mailing address:
  • Phone: 773-582-2660
  • Fax: 773-767-3022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. SUHA M ABDALLAH
Title or Position: PRESIDENT
Credential:
Phone: 708-307-7839