Provider Demographics
NPI:1780323808
Name:KHAKHKHAR, HARESH (PHARMD)
Entity type:Individual
Prefix:
First Name:HARESH
Middle Name:
Last Name:KHAKHKHAR
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 1:4909 W DIVISION ST STE 102
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60651-3108
Mailing Address - Country:US
Mailing Address - Phone:773-287-1200
Mailing Address - Fax:773-287-3594
Practice Address - Street 1:4909 W DIVISION ST STE 102
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60651-3108
Practice Address - Country:US
Practice Address - Phone:773-287-1200
Practice Address - Fax:773-287-3594
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-27
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44581183500000X
IL051-038418183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist