Healthcare Provider Details

I. General information

NPI: 1578167169
Provider Name (Legal Business Name): FAHAD AHMED PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/24/2020
Last Update Date: 11/24/2020
Certification Date: 11/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7100 S CICERO AVE
CHICAGO IL
60629-5813
US

IV. Provider business mailing address

7100 S CICERO AVE
CHICAGO IL
60629-5813
US

V. Phone/Fax

Practice location:
  • Phone: 708-563-9061
  • Fax:
Mailing address:
  • Phone: 708-563-9061
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number051.301470
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: