Healthcare Provider Details

I. General information

NPI: 1043813694
Provider Name (Legal Business Name): JAWAD H HAMDAN PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2020
Last Update Date: 11/17/2020
Certification Date: 11/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 W 26TH ST
CHICAGO IL
60623-4031
US

IV. Provider business mailing address

12621 ROSEMARY LN
PALOS PARK IL
60464-2000
US

V. Phone/Fax

Practice location:
  • Phone: 773-890-1800
  • Fax: 773-890-1802
Mailing address:
  • Phone: 708-336-9002
  • Fax: 708-229-2101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051-290360
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code1835N0905X
TaxonomyNuclear Pharmacist
License Number051290360
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code1835N1003X
TaxonomyNutrition Support Pharmacist
License Number051290360
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number051290360
License Number StateIL
# 5
Primary TaxonomyN
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License Number051290360
License Number StateIL
# 6
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number051290360
License Number StateIL
# 7
Primary TaxonomyN
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number051290360
License Number StateIL
# 8
Primary TaxonomyN
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License Number051290360
License Number StateIL
# 9
Primary TaxonomyN
Taxonomy Code1835C0205X
TaxonomyCritical Care Pharmacist
License Number051290360
License Number StateIL
# 10
Primary TaxonomyN
Taxonomy Code1835P0200X
TaxonomyPediatric Pharmacist
License Number051290360
License Number StateIL
# 11
Primary TaxonomyN
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number051290360
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: