Healthcare Provider Details

I. General information

NPI: 1629469945
Provider Name (Legal Business Name): MEDCOUNSEL PHARMACY CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2015
Last Update Date: 02/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14322 S WILL COOK RD
HOMER GLEN IL
60491-9211
US

IV. Provider business mailing address

14322 S WILL COOK RD
HOMER GLEN IL
60491-9211
US

V. Phone/Fax

Practice location:
  • Phone: 708-966-0785
  • Fax: 708-405-0038
Mailing address:
  • Phone: 708-966-0785
  • Fax: 708-405-0038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ZAIN RAZVI
Title or Position: PRESIDENT/PHARMACIST-IN-CHARGE
Credential: PHARMD
Phone: 708-966-0785