Provider Demographics
NPI:1154931186
Name:KHATTAB, MAHMOUD ABDELHAI (RPH)
Entity type:Individual
Prefix:
First Name:MAHMOUD
Middle Name:ABDELHAI
Last Name:KHATTAB
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9818 GALLOP LN
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46040-1577
Mailing Address - Country:US
Mailing Address - Phone:708-979-4770
Mailing Address - Fax:
Practice Address - Street 1:999 N ELMHURST RD
Practice Address - Street 2:
Practice Address - City:MOUNT PROSPECT
Practice Address - State:IL
Practice Address - Zip Code:60056-1133
Practice Address - Country:US
Practice Address - Phone:847-660-2028
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-04
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26028971A183500000X
IL051.302962183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist