Individual
IMTIYAZ M GHOGHAWALA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
12700 ROCKLAND RD, LAKE BLUFF, IL 60044-1420
(847) 615-2088
Mailing address
2598 HASTINGS LN, GURNEE, IL 60031-1077
(847) 672-6460
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
051-288964
IL
Other
Enumeration date
11/17/2011
Last updated
11/17/2011
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