Provider Demographics
NPI:1639781560
Name:THALJI, FATIMA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:FATIMA
Middle Name:
Last Name:THALJI
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 1:9025 TIMBERWOOD LN
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60487-2171
Mailing Address - Country:US
Mailing Address - Phone:708-548-6469
Mailing Address - Fax:
Practice Address - Street 1:9025 TIMBERWOOD LN
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60487-2171
Practice Address - Country:US
Practice Address - Phone:708-548-6469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-21
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051298965183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist