Provider Demographics
NPI:1447877642
Name:ALWAN, BAYAIN M (RPH)
Entity type:Individual
Prefix:
First Name:BAYAIN
Middle Name:M
Last Name:ALWAN
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 1:4741 N KEATING AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630-4580
Mailing Address - Country:US
Mailing Address - Phone:312-972-7964
Mailing Address - Fax:773-853-2972
Practice Address - Street 1:4312 N PULASKI RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60641-2150
Practice Address - Country:US
Practice Address - Phone:773-249-9100
Practice Address - Fax:773-853-2972
Is Sole Proprietor?:No
Enumeration Date:2020-07-03
Last Update Date:2020-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051301869183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist