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NPI Code Detail

MEDICARE: OLYMPIA FIELDS PHARMACY INC

MEDICARE: OLYMPIA FIELDS PHARMACY INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1332B00000XDurable Medical Equipment & Medical Supplies
2333600000XPharmacy
33336C0002XClinic Pharmacy
43336C0003XCommunity/Retail Pharmacy054015813IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12023192OTHERPK

General Provider Information

NPI Number : 1104930098
Entity Type Code : Organization
Provider Name (Legal Business Name) : OLYMPIA FIELDS PHARMACY INC
Provider Business Mailing Address
First Line : 966 W 21ST ST
Second Line : STE 104
City : CHICAGO
State : IL
Zip : 60608-4511
Country : US
Telephone Number : 312-226-2266
Fax Number : 312-226-9766
Provider Business Practice Location Address
First Line : 966 W 21ST ST
Second Line :
City : CHICAGO
State : IL
Zip : 60608-4511
Country : US
Telephone Number : 312-226-2266
Fax Number : 312-226-9766
Authorized Official
Title or Position : PHCY MGR
Name : AKIL GHOGAWALA
Credential : PHARM.D.
Telephone Number : 847-420-3789
Provider Enumeration Date : 08/18/2006
Last Update Date : 02/21/2017

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Directions to “OLYMPIA FIELDS PHARMACY INC ” Practice Location

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