Provider Demographics
NPI:1316644685
Name:TARIQ, SUMRAH (PHARMD)
Entity type:Individual
Prefix:DR
First Name:SUMRAH
Middle Name:
Last Name:TARIQ
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 1:1346 S 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60018-1431
Mailing Address - Country:US
Mailing Address - Phone:773-982-9118
Mailing Address - Fax:
Practice Address - Street 1:4001 MAIN ST
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-2751
Practice Address - Country:US
Practice Address - Phone:847-677-8133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-07
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0531305310183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist