Provider Demographics
NPI:1386036259
Name:ALYHABIB, KHADIGA
Entity Type:Individual
Prefix:
First Name:KHADIGA
Middle Name:
Last Name:ALYHABIB
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8200 W 87TH ST
Mailing Address - Street 2:1A
Mailing Address - City:HICKORY HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60457-1178
Mailing Address - Country:US
Mailing Address - Phone:708-629-5525
Mailing Address - Fax:
Practice Address - Street 1:8200 W 87TH ST
Practice Address - Street 2:1A
Practice Address - City:HICKORY HILLS
Practice Address - State:IL
Practice Address - Zip Code:60457-1178
Practice Address - Country:US
Practice Address - Phone:708-629-5525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-02
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051289577183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist