MEDICARE: KHATAU-MANEK LTD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy
2	3336C0004X	Compounding Pharmacy
3	3336C0003X	Community/Retail Pharmacy	054014811	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2017635	OTHER		PK

General Provider Information

NPI Number	:	1548202005
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KHATAU-MANEK LTD

Provider Business Mailing Address
First Line	:	1400 E GOLF RD
Second Line	:	SUITE 101
City	:	DES PLAINES
State	:	IL
Zip	:	60016-1236
Country	:	US
Telephone Number	:	847-296-1400
Fax Number	:	847-296-1431

Provider Business Practice Location Address
First Line	:	1400 E GOLF RD
Second Line	:	SUITE 101
City	:	DES PLAINES
State	:	IL
Zip	:	60016-1236
Country	:	US
Telephone Number	:	847-296-1400
Fax Number	:	847-296-1431

Authorized Official
Title or Position	:	PRESIDENT, PIC
Name	:	JIGNESH GANDHI
Credential	:
Telephone Number	:	847-296-1400

Provider Enumeration Date	:	06/11/2006
Last Update Date	:	05/01/2017

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Directions to “KHATAU-MANEK LTD ” Practice Location

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