Healthcare Provider Details

I. General information

NPI: 1487921425
Provider Name (Legal Business Name): HAKEEM IDRIS PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2011
Last Update Date: 11/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1533 E 67TH ST
CHICAGO IL
60637-4426
US

IV. Provider business mailing address

8016 S KENWOOD AVE
CHICAGO IL
60619-3413
US

V. Phone/Fax

Practice location:
  • Phone: 773-493-0733
  • Fax:
Mailing address:
  • Phone: 773-987-2525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051290120
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: