Provider Demographics
NPI:1316669690
Name:ABDELRAHMAN, ANWAR (PHARMD)
Entity type:Individual
Prefix:
First Name:ANWAR
Middle Name:
Last Name:ABDELRAHMAN
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 1:11859 SOUTHWEST HWY
Mailing Address - Street 2:
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463-1017
Mailing Address - Country:US
Mailing Address - Phone:708-671-1360
Mailing Address - Fax:
Practice Address - Street 1:11859 SOUTHWEST HWY
Practice Address - Street 2:
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-1017
Practice Address - Country:US
Practice Address - Phone:708-671-1360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-14
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051304543183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist