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General NPI Number Information
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NPI Number | 1679918403
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Entity Type | Organization
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Legal Business Name | CONVEX PHARMACY, LLC
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Dates
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Enumeration Date | 05/07/2013
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Last Update Date | 02/12/2021
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Provider Practice Location Address
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Address Line | 14400 JOHN HUMPHREY DR SUITE 110
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City | ORLAND PARK
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State | IL
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Zip | 60462-2897
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Country | US
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Telephone | 708-460-4930
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Fax | 708-460-4932
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Provider Business Mailing Address
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Address Line | 14400 JOHN HUMPHREY DR SUITE 110
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City | ORLAND PARK
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State | IL
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Zip | 60462-2897
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Country | US
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Telephone | 708-460-4930
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Fax | 708-460-4932
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Authorized Official
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Title or Position | PRESIDENT / OWNER
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Name | MARYAM ALRAZZAQ
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Credential | PHARM D
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Telephone | 708-460-4930
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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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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number | 054.018565
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License Number State | IL
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