Healthcare Provider Details

I. General information

NPI: 1396459582
Provider Name (Legal Business Name): WARDA AHMED
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2023
Last Update Date: 01/11/2023
Certification Date: 01/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

589 N MCLEAN BLVD
ELGIN IL
60123-3243
US

IV. Provider business mailing address

441 CROMWELL CIR UNIT 3
BARTLETT IL
60103-7450
US

V. Phone/Fax

Practice location:
  • Phone: 847-697-9873
  • Fax: 847-697-6769
Mailing address:
  • Phone: 630-677-2530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051301738
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: