Provider Demographics
NPI:1649908450
Name:HANASH, SAMAR M (PHARMD)
Entity type:Individual
Prefix:DR
First Name:SAMAR
Middle Name:M
Last Name:HANASH
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 1:3615 N CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60634-2753
Mailing Address - Country:US
Mailing Address - Phone:773-283-2355
Mailing Address - Fax:
Practice Address - Street 1:7122 W STRONG ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60656-3817
Practice Address - Country:US
Practice Address - Phone:773-656-4377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-10
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051304822183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist