Provider Demographics
NPI:1760088405
Name:KHOSHABA, NAHREN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:NAHREN
Middle Name:
Last Name:KHOSHABA
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 1:300 W BARTLETT AVE
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:IL
Mailing Address - Zip Code:60103-4002
Mailing Address - Country:US
Mailing Address - Phone:630-855-5178
Mailing Address - Fax:630-855-5672
Practice Address - Street 1:300 W BARTLETT AVE
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:IL
Practice Address - Zip Code:60103-4002
Practice Address - Country:US
Practice Address - Phone:630-855-5178
Practice Address - Fax:630-855-5672
Is Sole Proprietor?:No
Enumeration Date:2020-12-08
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051292140183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL051292140OtherSTATE LICENSE