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General NPI Number Information
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NPI Number | 1689176620
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Entity Type | Individual
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Provider Name | MOTAZ NASSAN
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Gender | Male
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Dates
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Enumeration Date | 03/06/2018
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Last Update Date | 08/18/2022
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Provider Practice Location Address
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Address Line | 250 W 144TH ST
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City | RIVERDALE
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State | IL
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Zip | 60827-2733
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Country | US
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Telephone | 708-832-2943
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Fax |
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Provider Business Mailing Address
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Address Line | 10623 S 82ND AVE
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City | PALOS HILLS
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State | IL
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Zip | 60465-1835
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Country | US
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Telephone | 708-691-7779
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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 | 051301042
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 5302046325
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License Number State | MI
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