Provider Demographics
NPI:1295002236
Name:JANI, NISHA (RPH)
Entity Type:Individual
Prefix:
First Name:NISHA
Middle Name:
Last Name:JANI
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 N EMPRESS DR
Mailing Address - Street 2:
Mailing Address - City:HAWTHORN WOODS
Mailing Address - State:IL
Mailing Address - Zip Code:60047-3714
Mailing Address - Country:US
Mailing Address - Phone:847-791-4435
Mailing Address - Fax:224-656-5704
Practice Address - Street 1:330 DOVER LN
Practice Address - Street 2:
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60018-1136
Practice Address - Country:US
Practice Address - Phone:847-791-4435
Practice Address - Fax:224-656-5704
Is Sole Proprietor?:No
Enumeration Date:2011-11-18
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051039684183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist