Healthcare Provider Details

I. General information

NPI: 1972408276
Provider Name (Legal Business Name): ALPHA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

627 N YORK ST UNIT 154
ELMHURST IL
60126-1620
US

IV. Provider business mailing address

627 N YORK ST UNIT 154
ELMHURST IL
60126-1620
US

V. Phone/Fax

Practice location:
  • Phone: 902-102-1050
  • Fax:
Mailing address:
  • Phone: 902-102-1050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: RICARDO CRUZ NIEVES
Title or Position: MANAGER
Credential:
Phone: 902-102-1050