Provider Demographics
NPI:1407507254
Name:ORLAND PARK LED INC
Entity Type:Organization
Organization Name:ORLAND PARK LED INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HAYTHAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDELJABER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-717-7513
Mailing Address - Street 1:7914 SYCAMORE DR
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-4112
Mailing Address - Country:US
Mailing Address - Phone:708-717-7513
Mailing Address - Fax:
Practice Address - Street 1:7914 SYCAMORE DR
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-4112
Practice Address - Country:US
Practice Address - Phone:708-717-7513
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-13
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183700000XPharmacy Service ProvidersPharmacy TechnicianGroup - Single Specialty