Provider Demographics
NPI:1316694953
Name:MAHAFZAH, AHMED (PHARMD)
Entity type:Individual
Prefix:
First Name:AHMED
Middle Name:
Last Name:MAHAFZAH
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10837 S CICERO AVE STE 110C
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-6459
Mailing Address - Country:US
Mailing Address - Phone:708-529-7222
Mailing Address - Fax:708-529-7325
Practice Address - Street 1:10837 S CICERO AVE STE 110C
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-6459
Practice Address - Country:US
Practice Address - Phone:708-529-7222
Practice Address - Fax:708-529-7325
Is Sole Proprietor?:No
Enumeration Date:2022-03-03
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.295152183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist