Provider Demographics
NPI:1740874908
Name:VASNANI, JAYANTILAL DAMJIBHAI
Entity type:Individual
Prefix:
First Name:JAYANTILAL
Middle Name:DAMJIBHAI
Last Name:VASNANI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16713 LEE ST
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60467-8717
Mailing Address - Country:US
Mailing Address - Phone:708-460-9230
Mailing Address - Fax:
Practice Address - Street 1:16713 LEE ST
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60467-8717
Practice Address - Country:US
Practice Address - Phone:708-460-9230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-26
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0510330741835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy SpecialistGroup - Single Specialty