Provider Demographics
NPI:1265037758
Name:GHOSEIN, NUHA
Entity Type:Individual
Prefix:
First Name:NUHA
Middle Name:
Last Name:GHOSEIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NUHA
Other - Middle Name:
Other - Last Name:GHOSEIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:13350 BRITTANY DR
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-1316
Mailing Address - Country:US
Mailing Address - Phone:708-638-6675
Mailing Address - Fax:
Practice Address - Street 1:3200 FLOSSMOOR RD
Practice Address - Street 2:
Practice Address - City:FLOSSMOOR
Practice Address - State:IL
Practice Address - Zip Code:60422-4484
Practice Address - Country:US
Practice Address - Phone:708-798-4625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-02
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.303107183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist