Provider Demographics
NPI:1609476563
Name:CHAUDHURY, NISHATH (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:NISHATH
Middle Name:
Last Name:CHAUDHURY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:NISHATH
Other - Middle Name:
Other - Last Name:CHAUDHURY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:1205 S IL ROUTE 31
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-8213
Mailing Address - Country:US
Mailing Address - Phone:815-445-4409
Mailing Address - Fax:
Practice Address - Street 1:1205 S IL ROUTE 31
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-8213
Practice Address - Country:US
Practice Address - Phone:815-445-4409
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-29
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051298348183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist