Healthcare Provider Details

I. General information

NPI: 1982985289
Provider Name (Legal Business Name): ROHIT PANDYA RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2011
Last Update Date: 08/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9301 WAUKEGAN RD
MORTON GROVE IL
60053-1313
US

IV. Provider business mailing address

5038 JARVIS AVE
SKOKIE IL
60077-3312
US

V. Phone/Fax

Practice location:
  • Phone: 847-965-2444
  • Fax: 847-966-7133
Mailing address:
  • Phone: 847-676-8699
  • Fax: 847-966-7133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051-033159
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: