Provider Demographics
NPI:1598360778
Name:ALI, SYED SHABBIR (PHARMD)
Entity Type:Individual
Prefix:
First Name:SYED
Middle Name:SHABBIR
Last Name:ALI
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 1:6816 N TERRA VISTA DR
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-2418
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:CVS PHARMACY
Practice Address - Street 2:1773 E CHESTNUT STREET
Practice Address - City:CANTON
Practice Address - State:IL
Practice Address - Zip Code:61520
Practice Address - Country:US
Practice Address - Phone:309-647-1321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-03
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.300002183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist