Provider Demographics
NPI:1417557141
Name:BRAHMBHATT, SAMARTH I
Entity Type:Individual
Prefix:
First Name:SAMARTH
Middle Name:
Last Name:BRAHMBHATT
Suffix:I
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 1:1696 FOLTZ DR
Mailing Address - Street 2:
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60169-6956
Mailing Address - Country:US
Mailing Address - Phone:224-625-0615
Mailing Address - Fax:
Practice Address - Street 1:1006 N ROHLWING RD
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:IL
Practice Address - Zip Code:60101-1034
Practice Address - Country:US
Practice Address - Phone:630-424-0486
Practice Address - Fax:630-424-0602
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-30
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.296776183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist