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General NPI Number Information
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NPI Number | 1871406207
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Entity Type | Organization
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Legal Business Name | MEDLYRA SUPPLY LLC
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Dates
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Enumeration Date | 09/25/2026
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Last Update Date | 09/25/2026
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Provider Practice Location Address
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Address Line | 4001 W DEVON AVE STE 320
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City | CHICAGO
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State | IL
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Zip | 60646-4527
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Country | US
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Telephone | 312-479-4712
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Fax |
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Provider Business Mailing Address
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Address Line | 4001 W DEVON AVE STE 320
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City | CHICAGO
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State | IL
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Zip | 60646-4527
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Country | US
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Telephone | 312-479-4712
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MOHAMMED ASADULLAH SHOAIB
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Credential |
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Telephone | 312-479-4712
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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