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General NPI Number Information
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NPI Number | 1992049662
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Entity Type | Organization
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Legal Business Name | LUNA PHARMACY LTD
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Dates
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Enumeration Date | 11/19/2012
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Last Update Date | 07/30/2014
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Provider Practice Location Address
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Address Line | 5352 N LINCOLN AVE
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City | CHICAGO
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State | IL
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Zip | 60625-2316
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Country | US
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Telephone | 773-435-9902
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Fax | 773-435-9003
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Provider Business Mailing Address
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Address Line | 5352 N LINCOLN AVE
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City | CHICAGO
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State | IL
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Zip | 60625-2316
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Country | US
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Telephone | 773-435-9902
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Fax | 773-435-9903
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. AIMAN ALANFOUS
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Credential |
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Telephone | 773-435-9902
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 054.018025
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number | 054.018025
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 332BX2000X
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Taxonomy Name | Oxygen Equipment & Supplies (DME)
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License Number | 054.018025
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 054.018025
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License Number State | IL
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Taxonomy #5
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number | 054.018025
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License Number State | IL
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Taxonomy #6
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Taxonomy Code | 335G00000X
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Taxonomy Name | Medical Foods Supplier
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License Number | 054.018025
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License Number State | IL
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Taxonomy #7
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 054.018025
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License Number State | IL
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