Provider Demographics
NPI:1023821162
Name:FAYDI, YAZAN MUHANNAD (PHARMD)
Entity type:Individual
Prefix:
First Name:YAZAN
Middle Name:MUHANNAD
Last Name:FAYDI
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 1:1410 W WILSON AVE APT 3E
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-5431
Mailing Address - Country:US
Mailing Address - Phone:312-504-8856
Mailing Address - Fax:
Practice Address - Street 1:1410 W WILSON AVE APT 3E
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-5431
Practice Address - Country:US
Practice Address - Phone:312-504-8856
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-31
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.306776183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist