Healthcare Provider Details

I. General information

NPI: 1992309603
Provider Name (Legal Business Name): NOUR MAATOUK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/23/2020
Last Update Date: 11/23/2020
Certification Date: 11/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1154 S CLARK ST
CHICAGO IL
60605-2159
US

IV. Provider business mailing address

7704 MAPLE ST
MORTON GROVE IL
60053-1643
US

V. Phone/Fax

Practice location:
  • Phone: 312-212-6301
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051301053
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: