Provider Demographics
NPI:1952429441
Name:KOTHARI, TEJASH (PHARM D-RPH)
Entity type:Individual
Prefix:
First Name:TEJASH
Middle Name:
Last Name:KOTHARI
Suffix:
Gender:M
Credentials:PHARM D-RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5601 CAMBRIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:HANOVER PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60133-3657
Mailing Address - Country:US
Mailing Address - Phone:630-855-8171
Mailing Address - Fax:630-351-2978
Practice Address - Street 1:144 S GARY AVE
Practice Address - Street 2:
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-2225
Practice Address - Country:US
Practice Address - Phone:630-351-4433
Practice Address - Fax:630-351-2978
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53369183500000X
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist