Provider Demographics
NPI:1598862765
Name:DAVE, ASHISH
Entity Type:Individual
Prefix:
First Name:ASHISH
Middle Name:
Last Name:DAVE
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 1:200 N JEFFERSON ST
Mailing Address - Street 2:APT.1004
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60661-1195
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1415 LAKE COOK RD
Practice Address - Street 2:MS L449
Practice Address - City:DEERFIELD
Practice Address - State:IL
Practice Address - Zip Code:60015-5213
Practice Address - Country:US
Practice Address - Phone:847-964-6910
Practice Address - Fax:847-964-6767
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist