Provider Demographics
NPI:1336737485
Name:MUSLEH, FADI (PHARM D)
Entity type:Individual
Prefix:
First Name:FADI
Middle Name:
Last Name:MUSLEH
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1607 BENSON AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-3717
Mailing Address - Country:US
Mailing Address - Phone:847-227-8020
Mailing Address - Fax:846-868-8426
Practice Address - Street 1:1607 BENSON AVE
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-3717
Practice Address - Country:US
Practice Address - Phone:847-227-8020
Practice Address - Fax:847-868-8426
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-05
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051289766183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL464912051001Medicaid