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General NPI Number Information
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NPI Number | 1881351021
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Entity Type | Organization
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Legal Business Name | NIYRAA LLC
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Dates
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Enumeration Date | 11/22/2021
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Last Update Date | 09/22/2025
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Provider Practice Location Address
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Address Line | 741 S MCHENRY AVE STE E
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City | CRYSTAL LAKE
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State | IL
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Zip | 60014-7445
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Country | US
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Telephone | 815-701-1033
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Fax |
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Provider Business Mailing Address
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Address Line | 741 S MCHENRY AVE STE E
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City | CRYSTAL LAKE
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State | IL
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Zip | 60014-7445
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Country | US
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Telephone | 815-701-1033
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | MOHAMMED IBRAHIM QUADRI
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Credential |
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Telephone | 815-701-1033
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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