Provider Demographics
NPI:1083200448
Name:ABDEL-FATTAH, AMRO THARWAT
Entity Type:Individual
Prefix:
First Name:AMRO
Middle Name:THARWAT
Last Name:ABDEL-FATTAH
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 1:122 W WILSON ST
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:IL
Mailing Address - Zip Code:60510-1945
Mailing Address - Country:US
Mailing Address - Phone:630-406-9258
Mailing Address - Fax:630-406-1364
Practice Address - Street 1:122 W WILSON ST
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:IL
Practice Address - Zip Code:60510-1945
Practice Address - Country:US
Practice Address - Phone:630-406-9258
Practice Address - Fax:630-406-1364
Is Sole Proprietor?:No
Enumeration Date:2020-12-18
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.295483183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist