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General NPI Number Information
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NPI Number | 1407484439
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Entity Type | Organization
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Legal Business Name | YOUR PHARMACY
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Dates
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Enumeration Date | 03/27/2020
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Last Update Date | 03/27/2020
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Provider Practice Location Address
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Address Line | 4050 HEALTHWAY DR STE 100
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City | AURORA
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State | IL
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Zip | 60504-8184
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Country | US
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Telephone | 708-527-2204
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Fax |
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Provider Business Mailing Address
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Address Line | 6019 OAKLAND AVE
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City | OAK FOREST
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State | IL
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Zip | 60452-1848
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Country | US
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Telephone | 708-527-2204
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Fax |
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Authorized Official
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Title or Position | PHARMACIST
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Name | SHEREN ALSHWAIYAT
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Credential |
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Telephone | 708-527-2204
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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