Provider Demographics
NPI:1508608563
Name:REGI KURIAKOSE, NITHIYA
Entity type:Individual
Prefix:
First Name:NITHIYA
Middle Name:
Last Name:REGI KURIAKOSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8729 N MERRILL ST
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714-1922
Mailing Address - Country:US
Mailing Address - Phone:847-704-2235
Mailing Address - Fax:
Practice Address - Street 1:9000 N GREENWOOD AVE
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714-1408
Practice Address - Country:US
Practice Address - Phone:847-298-3050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-11
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.306175183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist