MEDICARE: SUHA AFFANEH RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	26028454A	IN
2	183500000X	Pharmacist	051.286994	IL

General Provider Information

NPI Number	:	1093302531
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUHA AFFANEH RPH

Provider Business Mailing Address
First Line	:	8997 BIG SABLE PT
Second Line	:
City	:	FRANKFORT
State	:	IL
Zip	:	60423-1786
Country	:	US
Telephone Number	:	708-646-8116
Fax Number	:

Provider Business Practice Location Address
First Line	:	1780 WALL ST
Second Line	:
City	:	MOUNT PROSPECT
State	:	IL
Zip	:	60056-5790
Country	:	US
Telephone Number	:	888-674-7287
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/30/2020
Last Update Date	:	12/30/2020

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Directions to “ SUHA AFFANEH RPH” Practice Location

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