Provider Demographics
NPI:1619577004
Name:THAKKAR, ASMITA (PHARMD)
Entity Type:Individual
Prefix:
First Name:ASMITA
Middle Name:
Last Name:THAKKAR
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 1:1317 E CHRISTINA CT
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-5026
Mailing Address - Country:US
Mailing Address - Phone:847-322-2768
Mailing Address - Fax:
Practice Address - Street 1:4626 W DIVERSEY AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60639-1829
Practice Address - Country:US
Practice Address - Phone:773-628-1883
Practice Address - Fax:773-628-1884
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051293917183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist