Provider Demographics
NPI:1871875310
Name:JAZI, NINOO K X (RPH)
Entity type:Individual
Prefix:MRS
First Name:NINOO
Middle Name:K
Last Name:JAZI
Suffix:X
Gender:F
Credentials:RPH
Other - Prefix:MRS
Other - First Name:NINOO
Other - Middle Name:K
Other - Last Name:JAZI
Other - Suffix:X
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:4555 MARILYN DR
Mailing Address - Street 2:
Mailing Address - City:LONG GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60047-5269
Mailing Address - Country:US
Mailing Address - Phone:847-719-2817
Mailing Address - Fax:
Practice Address - Street 1:4555 MARILYN DR
Practice Address - Street 2:
Practice Address - City:LONG GROVE
Practice Address - State:IL
Practice Address - Zip Code:60047-5269
Practice Address - Country:US
Practice Address - Phone:847-719-2887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-11
Last Update Date:2011-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0510396971835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist