Healthcare Provider Details

I. General information

NPI: 1114553807
Provider Name (Legal Business Name): MOKENA PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2020
Last Update Date: 04/26/2025
Certification Date: 04/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10937 FRONT ST
MOKENA IL
60448-1934
US

IV. Provider business mailing address

10937 FRONT ST
MOKENA IL
60448-1934
US

V. Phone/Fax

Practice location:
  • Phone: 708-995-5626
  • Fax: 708-995-5626
Mailing address:
  • Phone:
  • Fax: 708-995-5626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: PAUL SERAFIN
Title or Position: PHARMACIST IN CHARGE
Credential:
Phone: 708-995-5626