Healthcare Provider Details

I. General information

NPI: 1285540336
Provider Name (Legal Business Name): MASHAL JIWANI PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 W HARRISON ST
CHICAGO IL
60612-3714
US

IV. Provider business mailing address

2670 CLARA AVE
AURORA IL
60502-9653
US

V. Phone/Fax

Practice location:
  • Phone: 312-864-0200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051309025
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: