Provider Demographics
NPI:1033493028
Name:MOHIUDDIN, SHADAN T (RPH)
Entity Type:Individual
Prefix:MRS
First Name:SHADAN
Middle Name:T
Last Name:MOHIUDDIN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3232 LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:WILMETTE
Mailing Address - State:IL
Mailing Address - Zip Code:60091-1073
Mailing Address - Country:US
Mailing Address - Phone:847-251-1413
Mailing Address - Fax:
Practice Address - Street 1:3232 LAKE AVE
Practice Address - Street 2:
Practice Address - City:WILMETTE
Practice Address - State:IL
Practice Address - Zip Code:60091-1073
Practice Address - Country:US
Practice Address - Phone:847-251-1413
Practice Address - Fax:847-251-1683
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-07
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302038591183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist