Provider Demographics
NPI:1164174405
Name:MADNI, WAFA ZARA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:WAFA
Middle Name:ZARA
Last Name:MADNI
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 1:740 N ABERDEEN ST APT 817
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60642-6071
Mailing Address - Country:US
Mailing Address - Phone:773-430-0232
Mailing Address - Fax:
Practice Address - Street 1:7550 N OAK PARK AVE
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714-3820
Practice Address - Country:US
Practice Address - Phone:773-430-0232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-18
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.303290183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist