Provider Demographics
NPI:1154096303
Name:MATIN, NIMA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:NIMA
Middle Name:
Last Name:MATIN
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 1:17W735 BUTTERFIELD RD STE C
Mailing Address - Street 2:
Mailing Address - City:OAKBROOK TERRACE
Mailing Address - State:IL
Mailing Address - Zip Code:60181-4206
Mailing Address - Country:US
Mailing Address - Phone:630-828-6978
Mailing Address - Fax:
Practice Address - Street 1:17W735 BUTTERFIELD RD STE C
Practice Address - Street 2:
Practice Address - City:OAKBROOK TERRACE
Practice Address - State:IL
Practice Address - Zip Code:60181-4206
Practice Address - Country:US
Practice Address - Phone:630-828-6978
Practice Address - Fax:630-385-0122
Is Sole Proprietor?:No
Enumeration Date:2021-08-10
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051292344183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist