Provider Demographics
NPI:1407223761
Name:ITALIA, KHUSHBU (PHARMD)
Entity type:Individual
Prefix:
First Name:KHUSHBU
Middle Name:
Last Name:ITALIA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5146 BELDEN AVE
Mailing Address - Street 2:UNIT G2
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-4774
Mailing Address - Country:US
Mailing Address - Phone:847-401-8848
Mailing Address - Fax:
Practice Address - Street 1:1071 W CARL SANDBURG DR
Practice Address - Street 2:
Practice Address - City:GALESBURG
Practice Address - State:IL
Practice Address - Zip Code:61401-1343
Practice Address - Country:US
Practice Address - Phone:309-344-7886
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-21
Last Update Date:2015-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.298739183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist