Provider Demographics
NPI:1619715257
Name:SAJJAD, HASANATH MOHAMMEDI (RPH)
Entity type:Individual
Prefix:
First Name:HASANATH
Middle Name:MOHAMMEDI
Last Name:SAJJAD
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6337 N KEATING AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60646-4425
Mailing Address - Country:US
Mailing Address - Phone:773-691-6014
Mailing Address - Fax:
Practice Address - Street 1:5665 W TOUHY AVE
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714-4019
Practice Address - Country:US
Practice Address - Phone:847-647-6880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-17
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051306126183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist