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NPI Code Detail

MEDICARE: FIDA MOMANI

MEDICARE: FIDA MOMANI
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
1183500000XPharmacist051295753IL

General Provider Information

NPI Number : 1528661030
Entity Type Code : Individual
Provider Name (Legal Business Name) : FIDA MOMANI
Provider Business Mailing Address
First Line : 2020 E GRAND AVE
Second Line :
City : LINDENHURST
State : IL
Zip : 60046-9069
Country : US
Telephone Number : 849-356-4302
Fax Number :
Provider Business Practice Location Address
First Line : 2020 E GRAND AVE
Second Line :
City : LINDENHURST
State : IL
Zip : 60046-9069
Country : US
Telephone Number : 847-356-4302
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/17/2020
Last Update Date : 11/17/2020

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Directions to “ FIDA MOMANI ” Practice Location

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