Healthcare Provider Details

I. General information

NPI: 1356279475
Provider Name (Legal Business Name): RYVANA PHARMACY AND MEDICAL SUPPLIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11845 SOUTHWEST HWY UNIT 5
PALOS HEIGHTS IL
60463-1599
US

IV. Provider business mailing address

11845 SOUTHWEST HWY UNIT 5
PALOS HEIGHTS IL
60463-1599
US

V. Phone/Fax

Practice location:
  • Phone: 708-949-9148
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. MOTAZ SHAHEEN
Title or Position: MANAGER
Credential:
Phone: 708-949-9148