Provider Demographics
NPI:1124622584
Name:MATARIYEH, SOPHIA SAMI (PHARMD)
Entity type:Individual
Prefix:DR
First Name:SOPHIA
Middle Name:SAMI
Last Name:MATARIYEH
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 1:3545 MULLIGAN DR
Mailing Address - Street 2:
Mailing Address - City:WOODRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60517-3988
Mailing Address - Country:US
Mailing Address - Phone:708-691-3614
Mailing Address - Fax:
Practice Address - Street 1:3156 W 103RD ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60655-2010
Practice Address - Country:US
Practice Address - Phone:773-238-4941
Practice Address - Fax:773-238-5692
Is Sole Proprietor?:No
Enumeration Date:2020-11-25
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.293237183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist