Provider Demographics
NPI:1851488787
Name:ABDALLAH, HANI F (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:HANI
Middle Name:F
Last Name:ABDALLAH
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16112 SYD CREEK DR
Mailing Address - Street 2:
Mailing Address - City:HOMER GLEN
Mailing Address - State:IL
Mailing Address - Zip Code:60491-5606
Mailing Address - Country:US
Mailing Address - Phone:708-307-7839
Mailing Address - Fax:
Practice Address - Street 1:16112 SYD CREEK DR
Practice Address - Street 2:
Practice Address - City:HOMER GLEN
Practice Address - State:IL
Practice Address - Zip Code:60491-5606
Practice Address - Country:US
Practice Address - Phone:708-307-7839
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2015-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL05138672183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist