Healthcare Provider Details

I. General information

NPI: 1285552125
Provider Name (Legal Business Name): GAYATHRI DOLLU PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1505 E FLORIDA AVE APT 203
URBANA IL
61802-6096
US

IV. Provider business mailing address

1505 E FLORIDA AVE APT 203
URBANA IL
61802-6096
US

V. Phone/Fax

Practice location:
  • Phone: 847-305-9164
  • Fax:
Mailing address:
  • Phone: 847-305-9164
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051.308532
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: