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NPI Code Detail

MEDICARE: IBTISAM INC

MEDICARE: IBTISAM INC
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
13336C0003XCommunity/Retail Pharmacy

General Provider Information

NPI Number : 1184625410
Entity Type Code : Organization
Provider Name (Legal Business Name) : IBTISAM INC
Provider Business Mailing Address
First Line : 4254 W 55TH ST
Second Line :
City : CHICAGO
State : IL
Zip : 60632-4642
Country : US
Telephone Number : 773-582-2660
Fax Number : 773-767-3022
Provider Business Practice Location Address
First Line : 4254 W 55TH ST STE 101
Second Line :
City : CHICAGO
State : IL
Zip : 60632-4642
Country : US
Telephone Number : 773-582-2660
Fax Number : 773-767-3022
Authorized Official
Title or Position : OWNER
Name : MRS. SUHA ABDALLAH
Credential :
Telephone Number : 773-582-2660
Provider Enumeration Date : 08/09/2005
Last Update Date : 03/02/2023

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Directions to “IBTISAM INC ” Practice Location

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