Provider Demographics
NPI:1568743938
Name:HASSAN, AYSER Y (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:AYSER
Middle Name:Y
Last Name:HASSAN
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 1:16607 RICHARDS DR
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-8210
Mailing Address - Country:US
Mailing Address - Phone:708-207-8420
Mailing Address - Fax:
Practice Address - Street 1:111 S HALSTED ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60661-3507
Practice Address - Country:US
Practice Address - Phone:312-463-9142
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-30
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051291343183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist