Healthcare Provider Details

I. General information

NPI: 1396361291
Provider Name (Legal Business Name): SOUHANDA SEFIN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2020
Last Update Date: 06/17/2020
Certification Date: 06/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16W115 HILLSIDE LN
BURR RIDGE IL
60527-6269
US

IV. Provider business mailing address

16W115 HILLSIDE LN
BURR RIDGE IL
60527-6269
US

V. Phone/Fax

Practice location:
  • Phone: 813-735-6676
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number051301872
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: