Healthcare Provider Details

I. General information

NPI: 1467034421
Provider Name (Legal Business Name): FATIMA ZAFAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2021
Last Update Date: 08/25/2021
Certification Date: 08/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 E UNIVERSITY AVE
URBANA IL
61802-2500
US

IV. Provider business mailing address

302 E UNIVERSITY AVE
URBANA IL
61802-2500
US

V. Phone/Fax

Practice location:
  • Phone: 217-344-7201
  • Fax:
Mailing address:
  • Phone: 217-418-6169
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number049.262707
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: