Provider Demographics
NPI:1679850382
Name:BURNS, AMINAH KHADIJAH (PHARM D)
Entity type:Individual
Prefix:MRS
First Name:AMINAH
Middle Name:KHADIJAH
Last Name:BURNS
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4800 148TH ST
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:IL
Mailing Address - Zip Code:60445-3117
Mailing Address - Country:US
Mailing Address - Phone:708-687-1604
Mailing Address - Fax:708-687-1650
Practice Address - Street 1:4800 148TH ST
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:IL
Practice Address - Zip Code:60445-3117
Practice Address - Country:US
Practice Address - Phone:708-687-1604
Practice Address - Fax:708-687-1650
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-08
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.290835183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist