Healthcare Provider Details

I. General information

NPI: 1124372354
Provider Name (Legal Business Name): BINEESH MOYEED
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2012
Last Update Date: 11/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

239 GOLF MILL CTR
NILES IL
60714-5658
US

IV. Provider business mailing address

6043 N MOZART ST
CHICAGO IL
60659-2511
US

V. Phone/Fax

Practice location:
  • Phone: 847-768-9217
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051296356
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: