Healthcare Provider Details

I. General information

NPI: 1730437401
Provider Name (Legal Business Name): ESHA JAIDKA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2012
Last Update Date: 08/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 S 5TH AVE
HINES IL
60141-3030
US

IV. Provider business mailing address

565 W QUINCY ST UNIT 1317
CHICAGO IL
60661-2910
US

V. Phone/Fax

Practice location:
  • Phone: 708-202-2108
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number67790
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: