Healthcare Provider Details

I. General information

NPI: 1235541335
Provider Name (Legal Business Name): HEBA KAZOUN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2014
Last Update Date: 05/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2656 N ELSTON AVE
CHICAGO IL
60647-2019
US

IV. Provider business mailing address

100 E 14TH ST 2508
CHICAGO IL
60605-2889
US

V. Phone/Fax

Practice location:
  • Phone: 773-289-1012
  • Fax:
Mailing address:
  • Phone: 708-278-2088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051296764
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: