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General NPI Number Information
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NPI Number | 1043596943
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Entity Type | Individual
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Provider Name | ILYASAM SYED PHARM D
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Gender | Male
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Dates
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Enumeration Date | 10/25/2011
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Last Update Date | 10/25/2011
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Provider Practice Location Address
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Address Line | 15250 CEDAR AVE
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City | APPLE VALLEY
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State | MN
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Zip | 55124-7017
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Country | US
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Telephone | 952-432-5557
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Fax |
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Provider Business Mailing Address
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Address Line | 16535 ASHBY LN
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City | EDEN PRAIRIE
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State | MN
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Zip | 55346-1408
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Country | US
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Telephone | 952-270-3602
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 051-289757
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | 118131
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License Number State | MN
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