Provider Demographics
NPI:1558768564
Name:VOHRA, MUSTAK
Entity Type:Individual
Prefix:
First Name:MUSTAK
Middle Name:
Last Name:VOHRA
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 1:25 WAUKEGAN RD
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-8200
Mailing Address - Country:US
Mailing Address - Phone:847-724-4824
Mailing Address - Fax:847-724-4965
Practice Address - Street 1:25 WAUKEGAN RD
Practice Address - Street 2:
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60025-8200
Practice Address - Country:US
Practice Address - Phone:847-724-4824
Practice Address - Fax:847-724-4965
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-20
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051-038258183500000X
WI16982-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist