Provider Demographics
NPI:1699107920
Name:RAFIQUI, ALI AHMAD
Entity type:Individual
Prefix:
First Name:ALI
Middle Name:AHMAD
Last Name:RAFIQUI
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 1:4433 S PULASKI RD
Mailing Address - Street 2:T-1879
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60632-4010
Mailing Address - Country:US
Mailing Address - Phone:773-579-2121
Mailing Address - Fax:
Practice Address - Street 1:4433 S PULASKI RD
Practice Address - Street 2:T-1879
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60632-4010
Practice Address - Country:US
Practice Address - Phone:773-579-2121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-09
Last Update Date:2013-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051296728183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist