MEDICARE: AMIJAY CORPORATION

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
1	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	054011897	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2019502	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104930171
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMIJAY CORPORATION

Provider Business Mailing Address
First Line	:	3441 W NORTH AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-4841
Country	:	US
Telephone Number	:	773-772-6731
Fax Number	:	773-772-7860

Provider Business Practice Location Address
First Line	:	3441 W NORTH AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-4841
Country	:	US
Telephone Number	:	773-772-6731
Fax Number	:	773-772-7860

Authorized Official
Title or Position	:	RPH
Name	:	MUKESH PATEL
Credential	:
Telephone Number	:	773-772-6731

Provider Enumeration Date	:	08/18/2006
Last Update Date	:	02/28/2018

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Directions to “AMIJAY CORPORATION ” Practice Location

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