Provider Demographics
NPI:1992049662
Name:LUNA PHARMACY LTD
Entity type:Organization
Organization Name:LUNA PHARMACY LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:AIMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ALANFOUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-435-9902
Mailing Address - Street 1:5352 N LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-2316
Mailing Address - Country:US
Mailing Address - Phone:773-435-9902
Mailing Address - Fax:773-435-9903
Practice Address - Street 1:5352 N LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-2316
Practice Address - Country:US
Practice Address - Phone:773-435-9902
Practice Address - Fax:773-435-9003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-19
Last Update Date:2014-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL054.018025332B00000X, 332BC3200X, 332BX2000X, 333600000X, 3336C0003X, 3336C0004X, 335G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No335G00000XSuppliersMedical Foods Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1487594OtherNCPDP
IL1487594OtherNCPDP
IL=========001Medicaid