Healthcare Provider Details

I. General information

NPI: 1801324827
Provider Name (Legal Business Name): MEDCOUNSEL PHARMACY CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2017
Last Update Date: 06/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4326 N LINCOLN AVE
CHICAGO IL
60618-1712
US

IV. Provider business mailing address

4326 N LINCOLN AVE
CHICAGO IL
60618-1712
US

V. Phone/Fax

Practice location:
  • Phone: 773-267-1992
  • Fax: 708-405-0038
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ZAIN RAZVI
Title or Position: PRESIDENT
Credential: PHARMD
Phone: 773-308-5275