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Individual

FEDAA BALLOUTA

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
3145 W 147TH ST, POSEN, IL 60469-1438
(708) 385-8922
Mailing address
6955 HERITAGE CIR APT 1D, ORLAND PARK, IL 60462-5158
(708) 733-0544

Taxonomy

Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
051302641
IL

Other

Enumeration date
10/01/2020
Last updated
10/01/2020
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