Provider Demographics
NPI:1245982727
Name:MALICK, EMAD (PHARMD)
Entity type:Individual
Prefix:DR
First Name:EMAD
Middle Name:
Last Name:MALICK
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 1:284 HEATHERFIELD LN
Mailing Address - Street 2:
Mailing Address - City:DEKALB
Mailing Address - State:IL
Mailing Address - Zip Code:60115-1844
Mailing Address - Country:US
Mailing Address - Phone:815-757-6644
Mailing Address - Fax:
Practice Address - Street 1:6560 E STATE ST
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-2545
Practice Address - Country:US
Practice Address - Phone:815-227-9777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-25
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.304557183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist