Healthcare Provider Details

I. General information

NPI: 1780288704
Provider Name (Legal Business Name): TESNEEM OTHMAN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2020
Last Update Date: 11/30/2020
Certification Date: 11/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6210 MAIN ST
DOWNERS GROVE IL
60516-1908
US

IV. Provider business mailing address

1041 CAROL ST
DOWNERS GROVE IL
60516-2828
US

V. Phone/Fax

Practice location:
  • Phone: 630-968-3276
  • Fax:
Mailing address:
  • Phone: 630-487-9653
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051302536
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: