Provider Demographics
NPI:1750659918
Name:ELACKATTU, ALISHA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ALISHA
Middle Name:
Last Name:ELACKATTU
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 1:999 W. MAIN STREET
Mailing Address - Street 2:T0903
Mailing Address - City:WEST DUNDEE
Mailing Address - State:IL
Mailing Address - Zip Code:60118
Mailing Address - Country:US
Mailing Address - Phone:847-836-1070
Mailing Address - Fax:
Practice Address - Street 1:999 W MAIN ST
Practice Address - Street 2:T0903
Practice Address - City:WEST DUNDEE
Practice Address - State:IL
Practice Address - Zip Code:60118-2059
Practice Address - Country:US
Practice Address - Phone:847-836-1070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-02
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051295349183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist