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General NPI Number Information
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NPI Number | 1134491228
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Entity Type | Individual
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Provider Name | GURDEV R DHAWAN R.PH
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Gender | Male
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Dates
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Enumeration Date | 02/03/2012
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Last Update Date | 02/03/2012
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Provider Practice Location Address
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Address Line | 466 NELSON RD
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City | NEW LENOX
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State | IL
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Zip | 60451-2946
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Country | US
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Telephone | 815-485-2735
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Fax |
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Provider Business Mailing Address
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Address Line | 17362 GRANGE DR
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City | ORLAND PARK
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State | IL
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Zip | 60467-7592
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Country | US
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Telephone | 708-479-8538
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 051032065
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License Number State | IL
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