Provider Demographics
NPI:1194173179
Name:DHINGRA, DEEPAK
Entity type:Individual
Prefix:MR
First Name:DEEPAK
Middle Name:
Last Name:DHINGRA
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 1:2530 US HIGHWAY 30
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:IL
Mailing Address - Zip Code:60543-0000
Mailing Address - Country:US
Mailing Address - Phone:630-892-0030
Mailing Address - Fax:
Practice Address - Street 1:2530 US HIGHWAY 30
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:IL
Practice Address - Zip Code:60543-8975
Practice Address - Country:US
Practice Address - Phone:630-892-0030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-31
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051286614183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist