Provider Demographics
NPI:1750662847
Name:BAWLA, MEHREEN (RPH)
Entity Type:Individual
Prefix:MRS
First Name:MEHREEN
Middle Name:
Last Name:BAWLA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 GREENBRIAR DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60139-4507
Mailing Address - Country:US
Mailing Address - Phone:630-868-7392
Mailing Address - Fax:
Practice Address - Street 1:840 N MAIN ST
Practice Address - Street 2:
Practice Address - City:GLEN ELLYN
Practice Address - State:IL
Practice Address - Zip Code:60137-3641
Practice Address - Country:US
Practice Address - Phone:630-790-2087
Practice Address - Fax:630-790-2231
Is Sole Proprietor?:No
Enumeration Date:2011-09-01
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051287956183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist