Provider Demographics
NPI:1699370775
Name:ABDELJABER, DEYA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:DEYA
Middle Name:
Last Name:ABDELJABER
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 1:7914 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:708-890-6031
Mailing Address - Fax:
Practice Address - Street 1:3201 W 95TH ST
Practice Address - Street 2:
Practice Address - City:EVERGREEN PARK
Practice Address - State:IL
Practice Address - Zip Code:60805-2315
Practice Address - Country:US
Practice Address - Phone:708-499-8011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-04
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051303104183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist