MEDICARE: MARYEH HUSSAIN PHARMD

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	051300498	IL

General Provider Information

NPI Number	:	1649795782
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARYEH HUSSAIN PHARMD

Provider Business Mailing Address
First Line	:	9549 FOREST PL
Second Line	:
City	:	DES PLAINES
State	:	IL
Zip	:	60016-1515
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1601 N MILWAUKEE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-5411
Country	:	US
Telephone Number	:	773-342-9161
Fax Number	:

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

Provider Enumeration Date	:	08/10/2017
Last Update Date	:	08/10/2017

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