Healthcare Provider Details

I. General information

NPI: 1760088405
Provider Name (Legal Business Name): NAHREN KHOSHABA PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2020
Last Update Date: 12/15/2020
Certification Date: 12/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W BARTLETT AVE
BARTLETT IL
60103-4002
US

IV. Provider business mailing address

300 W BARTLETT AVE
BARTLETT IL
60103-4002
US

V. Phone/Fax

Practice location:
  • Phone: 630-855-5178
  • Fax: 630-855-5672
Mailing address:
  • Phone: 630-855-5178
  • Fax: 630-855-5672

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051292140
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: