MEDICARE: ASHISH DAVE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist		IL

General Provider Information

NPI Number	:	1598862765
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHISH DAVE

Provider Business Mailing Address
First Line	:	200 N JEFFERSON ST
Second Line	:	APT.1004
City	:	CHICAGO
State	:	IL
Zip	:	60661-1195
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1415 LAKE COOK RD
Second Line	:	MS L449
City	:	DEERFIELD
State	:	IL
Zip	:	60015-5213
Country	:	US
Telephone Number	:	847-964-6910
Fax Number	:	847-964-6767

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	07/08/2007

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Directions to “ ASHISH DAVE ” Practice Location

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