Healthcare Provider Details

I. General information

NPI: 1104754266
Provider Name (Legal Business Name): QURATULAIN CHHABRA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: QURATULAIN YOUSUF

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1275 N GALENA AVE
DIXON IL
61021-1001
US

IV. Provider business mailing address

565 STONEGATE DR
SYCAMORE IL
60178-8907
US

V. Phone/Fax

Practice location:
  • Phone: 224-256-0028
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051.308315
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: