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General NPI Number Information
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NPI Number | 1801661236
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Entity Type | Individual
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Provider Name | MOHAMMAD JEAFAR RPH
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Gender | Male
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Dates
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Enumeration Date | 11/15/2023
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Last Update Date | 11/15/2023
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Provider Practice Location Address
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Address Line | 1930 W 103RD ST
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City | CHICAGO
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State | IL
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Zip | 60643-2625
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Country | US
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Telephone | 773-239-8041
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Fax |
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Provider Business Mailing Address
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Address Line | 360 E SOUTH WATER ST APT 4711
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City | CHICAGO
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State | IL
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Zip | 60601-4158
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Country | US
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Telephone | 313-674-0214
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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 | 051.305993
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License Number State | IL
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