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NPI Code Detail

MEDICARE: MRS. SHADAN T MOHIUDDIN RPH

MEDICARE: MRS. SHADAN T MOHIUDDIN RPH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist5302038591MI

General Provider Information

NPI Number : 1033493028
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. SHADAN T MOHIUDDIN RPH
Provider Business Mailing Address
First Line : 3232 LAKE AVE
Second Line :
City : WILMETTE
State : IL
Zip : 60091-1073
Country : US
Telephone Number : 847-251-1413
Fax Number :
Provider Business Practice Location Address
First Line : 3232 LAKE AVE
Second Line :
City : WILMETTE
State : IL
Zip : 60091-1073
Country : US
Telephone Number : 847-251-1413
Fax Number : 847-251-1683
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/07/2011
Last Update Date : 01/11/2023

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