Healthcare Provider Details

I. General information

NPI: 1710527593
Provider Name (Legal Business Name): SIMA MERAI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2020
Last Update Date: 01/09/2020
Certification Date: 01/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5140 N CALIFORNIA AVE STE G105
CHICAGO IL
60625-3645
US

IV. Provider business mailing address

5140 N CALIFORNIA AVE STE G105
CHICAGO IL
60625-3645
US

V. Phone/Fax

Practice location:
  • Phone: 773-989-3980
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051300833
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: