Motaz Nassan
Individual provider Active NPI Pharmacist · Riverdale, IL
NPI 1689176620 · NPPES record last updated Aug 18, 2022
Key facts
- NPI
- 1689176620
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 5302046325 (MI)
- Practice address
- 250 W 144TH St
Riverdale, IL 60827-2733 - Phone
- (708) 832-2943
- NPI assigned
- Mar 6, 2018
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 051301042 | IL | MD | Pharmacist |
| 5302046325 | MI | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Highland Park CVS, L.L.C. | Past |
Accepting new patients | |
| Perry Drug Stores Inc and Subsidiaries | Past | Accepting new patients | |
| Perry Drug Stores Inc and Subsidiaries | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist |
183500000X | 051301042 | IL | |
| Pharmacist |
183500000X | 5302046325 | MI | Yes |
Addresses
Primary practice location
250 W 144TH St
Riverdale, IL 60827-2733
Mailing address
10623 S 82ND Ave
Palos Hills, IL 60465-1835
Phone (708) 691-7779
Other providers in Riverdale, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 18, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.