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General NPI Number Information
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NPI Number | 1578737409
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Entity Type | Organization
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Legal Business Name | 87TH & HARLEM CRESCENT PHARMACY INC
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Dates
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Enumeration Date | 04/22/2008
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Last Update Date | 07/11/2024
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Provider Practice Location Address
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Address Line | 7261 W 87TH ST
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City | BRIDGEVIEW
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State | IL
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Zip | 60455-1821
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Country | US
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Telephone | 708-598-0505
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Fax | 708-598-0606
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Provider Business Mailing Address
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Address Line | 7261 W 87TH ST
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City | BRIDGEVIEW
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State | IL
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Zip | 60455-1821
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Country | US
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Telephone | 708-598-0505
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Fax | 708-598-0606
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Authorized Official
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Title or Position | PIC
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Name | MUHAMMAD TAHA
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Credential |
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Telephone | 708-598-0505
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 054016428
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License Number State | IL
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