Provider Demographics
NPI:1649516303
Name:THAKAR, NISHANT B (PHARMD)
Entity type:Individual
Prefix:
First Name:NISHANT
Middle Name:B
Last Name:THAKAR
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5513 RIDGE XING
Mailing Address - Street 2:
Mailing Address - City:HANOVER PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60133-5370
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4949 HARRISON AVE
Practice Address - Street 2:STE 128
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-7987
Practice Address - Country:US
Practice Address - Phone:815-397-1587
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-27
Last Update Date:2012-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.295750183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist