Healthcare Provider Details

I. General information

NPI: 1043049679
Provider Name (Legal Business Name): YUSIF BASSAM ABED
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2024
Last Update Date: 07/31/2024
Certification Date: 07/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9534 S ROBERTS RD
HICKORY HILLS IL
60457-2239
US

IV. Provider business mailing address

9111 SUNRISE LN
ORLAND PARK IL
60462-4728
US

V. Phone/Fax

Practice location:
  • Phone: 708-598-0500
  • Fax: 708-598-8684
Mailing address:
  • Phone: 708-789-3131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051306414
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: