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NPI Code Detail

MEDICARE: BIENESTAR PHARMACY III, INC

MEDICARE: BIENESTAR PHARMACY III, 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
13336C0002XClinic Pharmacy
23336C0003XCommunity/Retail Pharmacy
3333600000XPharmacy054020244IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12168803OTHERPK

General Provider Information

NPI Number : 1447783915
Entity Type Code : Organization
Provider Name (Legal Business Name) : BIENESTAR PHARMACY III, INC
Provider Business Mailing Address
First Line : 2359 S WESTERN AVE
Second Line : SUITE 100
City : CHICAGO
State : IL
Zip : 60608-3837
Country : US
Telephone Number : 773-869-5200
Fax Number : 773-869-5222
Provider Business Practice Location Address
First Line : 2359 S WESTERN AVE
Second Line : SUITE 100
City : CHICAGO
State : IL
Zip : 60608-3837
Country : US
Telephone Number : 773-869-5200
Fax Number : 773-869-5222
Authorized Official
Title or Position : PRESIDENT
Name : AKIL GHOGHAWALA
Credential :
Telephone Number : 773-924-6000
Provider Enumeration Date : 04/11/2017
Last Update Date : 04/11/2017

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Directions to “BIENESTAR PHARMACY III, INC ” Practice Location

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