Provider Demographics
NPI:1558964650
Name:EL-QUESNY, SANAM (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SANAM
Middle Name:
Last Name:EL-QUESNY
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 1:762 CIRQUE DR
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-7502
Mailing Address - Country:US
Mailing Address - Phone:219-308-8029
Mailing Address - Fax:
Practice Address - Street 1:6445 CALUMET AVE
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:IN
Practice Address - Zip Code:46324-1206
Practice Address - Country:US
Practice Address - Phone:219-937-8521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-19
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26026214A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist