Provider Demographics
NPI:1073395059
Name:AL CHARBJI, BARAA
Entity Type:Individual
Prefix:
First Name:BARAA
Middle Name:
Last Name:AL CHARBJI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7210 BAYBERRY LN
Mailing Address - Street 2:
Mailing Address - City:DARIEN
Mailing Address - State:IL
Mailing Address - Zip Code:60561-3708
Mailing Address - Country:US
Mailing Address - Phone:630-828-3267
Mailing Address - Fax:
Practice Address - Street 1:6800 OGDEN AVE
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402-3643
Practice Address - Country:US
Practice Address - Phone:630-828-3267
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-16
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.305867183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist