Healthcare Provider Details

I. General information

NPI: 1275252678
Provider Name (Legal Business Name): SAMEH ATTIA PHARMA-D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2022
Last Update Date: 08/26/2022
Certification Date: 08/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 W ROOSEVELT RD
CHICAGO IL
60624-4339
US

IV. Provider business mailing address

5101 N CUMBERLAND AVE
NORRIDGE IL
60706-3028
US

V. Phone/Fax

Practice location:
  • Phone: 773-542-1232
  • Fax: 773-542-8327
Mailing address:
  • Phone: 708-953-1111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051.292423
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: