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General NPI Number Information
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NPI Number | 1801504048
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Entity Type | Organization
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Legal Business Name | SOUTHWEST EXPRESS PHARMACY INC
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Dates
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Enumeration Date | 11/07/2022
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Last Update Date | 11/07/2022
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Provider Practice Location Address
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Address Line | 11164 SOUTHWEST HWY
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City | PALOS HILLS
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State | IL
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Zip | 60465-2709
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Country | US
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Telephone | 708-541-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 11164 SOUTHWEST HWY
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City | PALOS HILLS
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State | IL
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Zip | 60465-2709
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MR. WISAM ABDALLAH
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Credential |
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Telephone | 708-837-1233
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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 |
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License Number State |
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