Provider Demographics
NPI:1548202005
Name:KHATAU-MANEK LTD
Entity Type:Organization
Organization Name:KHATAU-MANEK LTD
Other - Org Name:HOLY FAMILY PLAZA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT, PIC
Authorized Official - Prefix:
Authorized Official - First Name:JIGNESH
Authorized Official - Middle Name:
Authorized Official - Last Name:GANDHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-296-1400
Mailing Address - Street 1:1400 E GOLF RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-1236
Mailing Address - Country:US
Mailing Address - Phone:847-296-1400
Mailing Address - Fax:847-296-1431
Practice Address - Street 1:1400 E GOLF RD
Practice Address - Street 2:SUITE 101
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-1236
Practice Address - Country:US
Practice Address - Phone:847-296-1400
Practice Address - Fax:847-296-1431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
IL0540148113336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL304331300001Medicaid
2017635OtherPK