Healthcare Provider Details

I. General information

NPI: 1952210544
Provider Name (Legal Business Name): AHMAD DORAR SHALABEY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
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:
Mailing address:
  • Phone: 773-424-0541
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number049316381
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: