Provider Demographics
NPI:1114227113
Name:MYFTARI, KLODIANA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KLODIANA
Middle Name:
Last Name:MYFTARI
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1127 S YORK RD
Mailing Address - Street 2:
Mailing Address - City:BENSENVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60106-3342
Mailing Address - Country:US
Mailing Address - Phone:630-283-0181
Mailing Address - Fax:630-238-0192
Practice Address - Street 1:1127 S YORK RD
Practice Address - Street 2:
Practice Address - City:BENSENVILLE
Practice Address - State:IL
Practice Address - Zip Code:60106-3342
Practice Address - Country:US
Practice Address - Phone:630-283-0181
Practice Address - Fax:630-238-0192
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-25
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051291911183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist