Provider Demographics
NPI:1376824862
Name:TALATI, RONAK (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:RONAK
Middle Name:
Last Name:TALATI
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 1:1212 OGDEN AVE
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:IL
Mailing Address - Zip Code:60538-5400
Mailing Address - Country:US
Mailing Address - Phone:630-820-4098
Mailing Address - Fax:630-820-5393
Practice Address - Street 1:1212 OGDEN AVE
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:IL
Practice Address - Zip Code:60538-5400
Practice Address - Country:US
Practice Address - Phone:630-820-4098
Practice Address - Fax:630-820-5393
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-29
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051293277183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist