Healthcare Provider Details

I. General information

NPI: 1902456916
Provider Name (Legal Business Name): NOOR ABDULRAHMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2019
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8549 S CICERO AVE
CHICAGO IL
60652-3504
US

IV. Provider business mailing address

8549 S CICERO AVE
CHICAGO IL
60652-3504
US

V. Phone/Fax

Practice location:
  • Phone: 773-424-0541
  • Fax: 773-306-2405
Mailing address:
  • Phone: 773-424-0541
  • Fax: 773-306-2405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051.301555
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: