MEDICARE: NAZLI SIDDIQUI PHARM D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	051.294937	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	051.294937	OTHER	IL	PHARMACIST LICENSE

General Provider Information

NPI Number	:	1003191891
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NAZLI SIDDIQUI PHARM D.

Provider Business Mailing Address
First Line	:	2506 FIELDS SOUTH DR APT 201
Second Line	:
City	:	CHAMPAIGN
State	:	IL
Zip	:	61822-3714
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2506 FIELDS SOUTH DR APT 201
Second Line	:
City	:	CHAMPAIGN
State	:	IL
Zip	:	61822-3714
Country	:	US
Telephone Number	:	217-607-2522
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/12/2011
Last Update Date	:	10/12/2011

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