Provider Demographics
NPI:1114251600
Name:VOOTKUR, ANIL (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ANIL
Middle Name:
Last Name:VOOTKUR
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 DEERFIELD DR
Mailing Address - Street 2:
Mailing Address - City:HAWTHORN WOODS
Mailing Address - State:IL
Mailing Address - Zip Code:60047-6505
Mailing Address - Country:US
Mailing Address - Phone:847-550-0675
Mailing Address - Fax:
Practice Address - Street 1:25 DEERFIELD DR
Practice Address - Street 2:
Practice Address - City:HAWTHORN WOODS
Practice Address - State:IL
Practice Address - Zip Code:60047-6505
Practice Address - Country:US
Practice Address - Phone:847-550-0675
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-30
Last Update Date:2009-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051287981183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist