Provider Demographics
NPI:1134263098
Name:CHOTALIA, RAJESH R (PHARMACIST)
Entity type:Individual
Prefix:MR
First Name:RAJESH
Middle Name:R
Last Name:CHOTALIA
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6615 N LAWNDALE AVE
Mailing Address - Street 2:
Mailing Address - City:LINCOLNWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60712-3709
Mailing Address - Country:US
Mailing Address - Phone:847-676-3219
Mailing Address - Fax:773-624-6080
Practice Address - Street 1:215 E 47TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60653-3903
Practice Address - Country:US
Practice Address - Phone:773-624-0010
Practice Address - Fax:773-624-6080
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051-032792183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL363255630001Medicaid
IL363255630001Medicaid