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General NPI Number Information
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NPI Number | 1639114952
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Entity Type | Organization
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Legal Business Name | FARMACIA LA FAMILIA
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Dates
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Enumeration Date | 06/19/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3824 S KEDZIE AVE
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City | CHICAGO
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State | IL
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Zip | 60632-2711
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Country | US
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Telephone | 773-847-0269
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Fax |
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Provider Business Mailing Address
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Address Line | 3824 S KEDZIE AVE
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City | CHICAGO
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State | IL
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Zip | 60632-2711
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Country | US
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Telephone | 773-847-0269
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Fax |
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Authorized Official
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Title or Position | CO-OWNER
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Name | DR. TIMOTHY LAVERY
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Credential | PHARM D
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Telephone | 773-847-0269
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number |
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License Number State | IL
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