Healthcare Provider Details

I. General information

NPI: 1770493678
Provider Name (Legal Business Name): ALI ALI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 FLOSSMOOR RD
FLOSSMOOR IL
60422-4484
US

IV. Provider business mailing address

3200 FLOSSMOOR RD
FLOSSMOOR IL
60422-4484
US

V. Phone/Fax

Practice location:
  • Phone: 708-798-4625
  • Fax: 708-798-4726
Mailing address:
  • Phone: 708-798-4625
  • Fax: 708-798-4726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051307371
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: