MEDICARE: DAHLIA SULTAN PHARMD

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	183500000X	Pharmacist	051298986	IL

General Provider Information

NPI Number	:	1710810551
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAHLIA SULTAN PHARMD

Provider Business Mailing Address
First Line	:	180 HARVESTER DR STE 190
Second Line	:
City	:	BURR RIDGE
State	:	IL
Zip	:	60527-6693
Country	:	US
Telephone Number	:	630-544-0980
Fax Number	:

Provider Business Practice Location Address
First Line	:	5758 S MARYLAND AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60637-1426
Country	:	US
Telephone Number	:	773-834-1912
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/03/2026
Last Update Date	:	06/03/2026

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