Provider Demographics
NPI:1295328912
Name:IFTEIH, MAHDI DIAB (CPHT)
Entity type:Individual
Prefix:MR
First Name:MAHDI
Middle Name:DIAB
Last Name:IFTEIH
Suffix:
Gender:M
Credentials:CPHT
Other - Prefix:MR
Other - First Name:MAHDI
Other - Middle Name:DIAB
Other - Last Name:IFTEIH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CPHT
Mailing Address - Street 1:6745 W MENOMINEE PKWY
Mailing Address - Street 2:
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463-1717
Mailing Address - Country:US
Mailing Address - Phone:708-477-1995
Mailing Address - Fax:
Practice Address - Street 1:12290 S PULASKI RD
Practice Address - Street 2:
Practice Address - City:ALSIP
Practice Address - State:IL
Practice Address - Zip Code:60803-1405
Practice Address - Country:US
Practice Address - Phone:708-385-2006
Practice Address - Fax:708-385-3124
Is Sole Proprietor?:No
Enumeration Date:2021-02-12
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL049.269642183700000X
183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician