Provider Demographics
NPI:1093302531
Name:AFFANEH, SUHA (RPH)
Entity Type:Individual
Prefix:
First Name:SUHA
Middle Name:
Last Name:AFFANEH
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8997 BIG SABLE PT
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:60423-1786
Mailing Address - Country:US
Mailing Address - Phone:708-646-8116
Mailing Address - Fax:
Practice Address - Street 1:1780 WALL ST
Practice Address - Street 2:
Practice Address - City:MOUNT PROSPECT
Practice Address - State:IL
Practice Address - Zip Code:60056-5790
Practice Address - Country:US
Practice Address - Phone:888-674-7287
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-30
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26028454A183500000X
IL051.286994183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist