Provider Demographics
NPI:1417132168
Name:FAHMI, BASSEM (PHARMD)
Entity Type:Individual
Prefix:
First Name:BASSEM
Middle Name:
Last Name:FAHMI
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2233 S HIGHLAND AVE APT 815
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-5331
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:FIFTH AVE. AND ROOSEVELT RD
Practice Address - Street 2:BUILDING 200
Practice Address - City:HINES
Practice Address - State:IL
Practice Address - Zip Code:60141-5331
Practice Address - Country:US
Practice Address - Phone:708-202-2088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-31
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist