Provider Demographics
NPI:1548539844
Name:MUSA, AYAT MUHANA (PHARMD)
Entity type:Individual
Prefix:
First Name:AYAT
Middle Name:MUHANA
Last Name:MUSA
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 1:8038 THOMAS ST
Mailing Address - Street 2:APARTMENT 3E
Mailing Address - City:JUSTICE
Mailing Address - State:IL
Mailing Address - Zip Code:60458-1617
Mailing Address - Country:US
Mailing Address - Phone:708-843-2936
Mailing Address - Fax:
Practice Address - Street 1:8038 THOMAS ST
Practice Address - Street 2:APARTMENT 3E
Practice Address - City:JUSTICE
Practice Address - State:IL
Practice Address - Zip Code:60458-1617
Practice Address - Country:US
Practice Address - Phone:708-843-2936
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-15
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051294883183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist