Provider Demographics
NPI:1740566967
Name:HARFOUSH, MOHAMMED ALI
Entity Type:Individual
Prefix:
First Name:MOHAMMED
Middle Name:ALI
Last Name:HARFOUSH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 W 87TH ST
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60565-2200
Mailing Address - Country:US
Mailing Address - Phone:630-778-7645
Mailing Address - Fax:630-778-1289
Practice Address - Street 1:63 W 87TH ST
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60565-2200
Practice Address - Country:US
Practice Address - Phone:651-451-1503
Practice Address - Fax:651-451-3650
Is Sole Proprietor?:No
Enumeration Date:2011-11-02
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN119188183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist