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General NPI Number Information
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NPI Number | 1083340038
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Entity Type | Individual
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Provider Name | MUSTAFA MOHAMMED ALI
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Gender | Male
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Dates
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Enumeration Date | 07/30/2022
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Last Update Date | 07/30/2022
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Provider Practice Location Address
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Address Line | 5630 W TOUHY AVE
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City | NILES
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State | IL
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Zip | 60714-4001
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Country | US
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Telephone | 847-647-8683
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Fax |
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Provider Business Mailing Address
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Address Line | 5537 N SAWYER AVE
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City | CHICAGO
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State | IL
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Zip | 60625-9037
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Country | US
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Telephone | 224-200-9831
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 051304695
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License Number State | IL
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