Provider Demographics
NPI:1588265326
Name:FIAZ, ZOHIB M
Entity type:Individual
Prefix:
First Name:ZOHIB
Middle Name:M
Last Name:FIAZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1508 S FAIRFIELD AVE APT 16B
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-4665
Mailing Address - Country:US
Mailing Address - Phone:847-219-1354
Mailing Address - Fax:
Practice Address - Street 1:1931 W CERMAK RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-4203
Practice Address - Country:US
Practice Address - Phone:773-847-5781
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-06
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051300068183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist