Provider Demographics
NPI:1225315542
Name:JINDAL, OM (RPH)
Entity Type:Individual
Prefix:
First Name:OM
Middle Name:
Last Name:JINDAL
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1952 SLIPPERY ROCK RD
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60565-6765
Mailing Address - Country:US
Mailing Address - Phone:630-983-8363
Mailing Address - Fax:
Practice Address - Street 1:6S235 STEEPLE RUN DR
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-3769
Practice Address - Country:US
Practice Address - Phone:630-717-9333
Practice Address - Fax:630-717-7135
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-15
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051-0336501835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy