Provider Demographics
NPI:1083353395
Name:ATIF, ABDUL MOYEED (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ABDUL
Middle Name:MOYEED
Last Name:ATIF
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1212 13TH AVE
Mailing Address - Street 2:
Mailing Address - City:MENDOTA
Mailing Address - State:IL
Mailing Address - Zip Code:61342-1411
Mailing Address - Country:US
Mailing Address - Phone:815-538-2095
Mailing Address - Fax:815-538-4050
Practice Address - Street 1:1212 13TH AVE
Practice Address - Street 2:
Practice Address - City:MENDOTA
Practice Address - State:IL
Practice Address - Zip Code:61342-1411
Practice Address - Country:US
Practice Address - Phone:815-538-2095
Practice Address - Fax:815-538-4050
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-03
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL049304037183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist