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General NPI Number Information
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NPI Number | 1215302922
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Entity Type | Individual
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Provider Name | MANGAL DHAMI
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Gender | Male
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Dates
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Enumeration Date | 12/07/2015
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Last Update Date | 12/07/2015
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Provider Practice Location Address
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Address Line | 1877 GROSSE POINTE CIRCLE
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City | HANOVE PARK
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State | IL
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Zip | 60133
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Country | US
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Telephone | 630-745-1692
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Fax |
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Provider Business Mailing Address
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Address Line | 1877 GROSSE POINTE CIR
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City | HANOVER PARK
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State | IL
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Zip | 60133-6723
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Country | US
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Telephone | 630-745-1692
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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 | PH60609752
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License Number State | WA
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