Provider Demographics
NPI:1821671934
Name:SAHAWNEH, FAISAL (PHARMD)
Entity Type:Individual
Prefix:
First Name:FAISAL
Middle Name:
Last Name:SAHAWNEH
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 1:1610 S CARPENTER ST APT 2N
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60608-2536
Mailing Address - Country:US
Mailing Address - Phone:708-663-2107
Mailing Address - Fax:
Practice Address - Street 1:11422 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643-4120
Practice Address - Country:US
Practice Address - Phone:312-462-0071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-05
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051298094183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist