Provider Demographics
NPI:1568065415
Name:VERGHESE, PREETHA P (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:PREETHA
Middle Name:P
Last Name:VERGHESE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3333 CENTRAL ST
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-1150
Mailing Address - Country:US
Mailing Address - Phone:847-869-3800
Mailing Address - Fax:847-869-6554
Practice Address - Street 1:3333 CENTRAL ST
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-1150
Practice Address - Country:US
Practice Address - Phone:847-869-3800
Practice Address - Fax:847-869-6554
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-20
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.286854183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist