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General NPI Number Information
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NPI Number | 1295328912
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Entity Type | Individual
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Provider Name | MAHDI DIAB IFTEIH CPHT
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Gender | Male
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Dates
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Enumeration Date | 02/12/2021
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Last Update Date | 02/12/2021
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Provider Practice Location Address
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Address Line | 12290 S PULASKI RD
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City | ALSIP
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State | IL
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Zip | 60803-1405
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Country | US
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Telephone | 708-385-2006
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Fax | 708-385-3124
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Provider Business Mailing Address
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Address Line | 6745 W MENOMINEE PKWY
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City | PALOS HEIGHTS
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State | IL
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Zip | 60463-1717
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Country | US
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Telephone | 708-477-1995
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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 | 183700000X
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Taxonomy Name | Pharmacy Technician
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License Number | 049.269642
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 183700000X
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Taxonomy Name | Pharmacy Technician
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License Number |
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License Number State |
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