MEDICARE: SUMMAYYA AHMED

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	051307456	IL

General Provider Information

NPI Number	:	1396618773
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUMMAYYA AHMED

Provider Business Mailing Address
First Line	:	1770 NAUTILUS LN
Second Line	:
City	:	HANOVER PARK
State	:	IL
Zip	:	60133-6119
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7700 FORSYTH BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63105-1813
Country	:	US
Telephone Number	:	732-861-5880
Fax Number	:

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

Provider Enumeration Date	:	09/24/2025
Last Update Date	:	09/24/2025

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Directions to “ SUMMAYYA AHMED ” Practice Location

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