=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851458848
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MERZ APOTHECARY, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/02/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4716 N LINCOLN AVE
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60625-2010
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-989-0900
-----------------------------------------------------
Fax | 773-989-8108
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4716 N LINCOLN AVE
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60625-2010
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-989-0900
-----------------------------------------------------
Fax | 773-989-8108
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. ABDUL QAIYUM
-----------------------------------------------------
Credential | R.PH.
-----------------------------------------------------
Telephone | 773-989-0900
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------