MEDICARE: MIRNA ALHUSSEINI 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	051-290378	IL

General Provider Information

NPI Number	:	1538744222
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIRNA ALHUSSEINI RPH

Provider Business Mailing Address
First Line	:	825 PARK AVE
Second Line	:
City	:	RIVER FOREST
State	:	IL
Zip	:	60305-1327
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	825 PARK AVE
Second Line	:
City	:	RIVER FOREST
State	:	IL
Zip	:	60305-1327
Country	:	US
Telephone Number	:	313-587-1374
Fax Number	:

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

Provider Enumeration Date	:	03/14/2021
Last Update Date	:	03/14/2021

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