Provider Demographics
NPI:1669005831
Name:KAMRAN, SHUMAILA (RPH)
Entity Type:Individual
Prefix:
First Name:SHUMAILA
Middle Name:
Last Name:KAMRAN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2377 S LEXINGTON DR APT 215
Mailing Address - Street 2:
Mailing Address - City:MOUNT PROSPECT
Mailing Address - State:IL
Mailing Address - Zip Code:60056-5923
Mailing Address - Country:US
Mailing Address - Phone:224-830-9517
Mailing Address - Fax:
Practice Address - Street 1:414 W LAKE ST
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:IL
Practice Address - Zip Code:60101-2305
Practice Address - Country:US
Practice Address - Phone:630-543-0988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-17
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051301809183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist