Healthcare Provider Details

I. General information

NPI: 1770748576
Provider Name (Legal Business Name): MAY LO BEWLEY BS PHARMACY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2008
Last Update Date: 07/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

FIFTH AVE AND ROOSEVELT, BLDG 37 CMOP
HINES IL
60141-5221
US

IV. Provider business mailing address

FIFTH AVE AND ROOSEVELT ROAD, BLDG 37 CMOP
HINES IL
60141-5221
US

V. Phone/Fax

Practice location:
  • Phone: 708-786-7820
  • Fax:
Mailing address:
  • Phone: 708-786-7820
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051-029899
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: