Provider Demographics
NPI:1497038749
Name:HAFEEZ, TARIQ (RPH)
Entity type:Individual
Prefix:MR
First Name:TARIQ
Middle Name:
Last Name:HAFEEZ
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6144 N NAGLE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60646-3610
Mailing Address - Country:US
Mailing Address - Phone:773-775-1350
Mailing Address - Fax:
Practice Address - Street 1:4820 N CUMBERLAND AVE
Practice Address - Street 2:
Practice Address - City:NORRIDGE
Practice Address - State:IL
Practice Address - Zip Code:60706-2914
Practice Address - Country:US
Practice Address - Phone:708-583-2133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-22
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.035060183500000X
CA44211183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist