Healthcare Provider Details

I. General information

NPI: 1285290221
Provider Name (Legal Business Name): HIBA ALHALABI PHARMACIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2019
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 ROYAL HEIGHTS CTR
BELLEVILLE IL
62226-5705
US

IV. Provider business mailing address

1 ROYAL HEIGHTS CTR
BELLEVILLE IL
62226-5705
US

V. Phone/Fax

Practice location:
  • Phone: 618-973-3879
  • Fax: 618-641-9801
Mailing address:
  • Phone: 618-973-3879
  • Fax: 618-641-9801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number051297878
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: