Provider Demographics
NPI:1790119535
Name:FARAJ, LANA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:LANA
Middle Name:
Last Name:FARAJ
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17550 HALSTED ST
Mailing Address - Street 2:
Mailing Address - City:HOMEWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60430-2006
Mailing Address - Country:US
Mailing Address - Phone:708-922-1588
Mailing Address - Fax:708-922-0116
Practice Address - Street 1:17550 HALSTED ST
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430-2006
Practice Address - Country:US
Practice Address - Phone:708-922-1588
Practice Address - Fax:708-922-0116
Is Sole Proprietor?:No
Enumeration Date:2013-08-28
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.295240183500000X
IN26024332A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist