Provider Demographics
NPI:1780964270
Name:SHUKLA, RUSHABH MUKESH (PHARMD)
Entity type:Individual
Prefix:
First Name:RUSHABH
Middle Name:MUKESH
Last Name:SHUKLA
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 1:500 NORTHWEST HWY
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:IL
Mailing Address - Zip Code:60013-2995
Mailing Address - Country:US
Mailing Address - Phone:847-516-3806
Mailing Address - Fax:847-516-2490
Practice Address - Street 1:500 NORTHWEST HWY
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:IL
Practice Address - Zip Code:60013-2995
Practice Address - Country:US
Practice Address - Phone:847-516-3806
Practice Address - Fax:847-516-2490
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-28
Last Update Date:2011-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.292495183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist