Provider Demographics
NPI:1609211093
Name:MEMON, ABBAS (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:ABBAS
Middle Name:
Last Name:MEMON
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2214 MULLIKIN DR
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61822-8300
Mailing Address - Country:US
Mailing Address - Phone:217-552-1202
Mailing Address - Fax:
Practice Address - Street 1:8001 LINCOLN AVE
Practice Address - Street 2:SUITE 800
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-3695
Practice Address - Country:US
Practice Address - Phone:847-588-7170
Practice Address - Fax:847-588-7060
Is Sole Proprietor?:No
Enumeration Date:2013-04-30
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051291882183500000X
MO2013012183183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist