Provider Demographics
NPI:1154934230
Name:BAKHSH, BUSHRAH (PHARM D)
Entity type:Individual
Prefix:
First Name:BUSHRAH
Middle Name:
Last Name:BAKHSH
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1471 VAN METER DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60139-2744
Mailing Address - Country:US
Mailing Address - Phone:630-699-0653
Mailing Address - Fax:
Practice Address - Street 1:1680 W LANE RD
Practice Address - Street 2:
Practice Address - City:MACHESNEY PARK
Practice Address - State:IL
Practice Address - Zip Code:61115-1623
Practice Address - Country:US
Practice Address - Phone:815-282-1203
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-28
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.2989393336M0003X
IL051298939183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No3336M0003XSuppliersPharmacyManaged Care Organization Pharmacy