Provider Demographics
NPI:1326008343
Name:MEHTA, TUSHAR M
Entity Type:Individual
Prefix:
First Name:TUSHAR
Middle Name:M
Last Name:MEHTA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 N LAKE SHORE DR # 22GH
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-5215
Mailing Address - Country:US
Mailing Address - Phone:630-430-3663
Mailing Address - Fax:630-582-0228
Practice Address - Street 1:310 OTTAWA LN
Practice Address - Street 2:
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-2788
Practice Address - Country:US
Practice Address - Phone:630-430-3663
Practice Address - Fax:708-344-3668
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051286565183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist