Provider Demographics
NPI:1376944868
Name:AHMED, RIZWAN ALI (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:RIZWAN
Middle Name:ALI
Last Name:AHMED
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 1:1837 WINDING RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:ROMEOVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60446-3939
Mailing Address - Country:US
Mailing Address - Phone:773-701-1360
Mailing Address - Fax:
Practice Address - Street 1:1212 OGDEN AVE
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:IL
Practice Address - Zip Code:60538-5400
Practice Address - Country:US
Practice Address - Phone:630-820-5393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-16
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051297993183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist