Provider Demographics
NPI:1174397772
Name:HAMDAN, BASEM KHADER (PHARMD)
Entity type:Individual
Prefix:
First Name:BASEM
Middle Name:KHADER
Last Name:HAMDAN
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 1:7051 W 86TH ST
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:IL
Mailing Address - Zip Code:60459-2222
Mailing Address - Country:US
Mailing Address - Phone:708-921-8273
Mailing Address - Fax:
Practice Address - Street 1:7878 S HARLEM AVE
Practice Address - Street 2:
Practice Address - City:BRIDGEVIEW
Practice Address - State:IL
Practice Address - Zip Code:60455-1532
Practice Address - Country:US
Practice Address - Phone:708-496-7806
Practice Address - Fax:708-496-9350
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-14
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051305986183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist