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NPI Code Detail

MEDICARE: BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS

MEDICARE: BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
13336C0002XClinic Pharmacy054.017116IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1054017116OTHERILSTATE LICENSE NUMBER
21453428OTHERILNCPDP NUMBER
3032-005923OTHERILSTATE CONTROLLED SUBSTANC

General Provider Information

NPI Number : 1669512323
Entity Type Code : Organization
Provider Name (Legal Business Name) : BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS
Provider Business Mailing Address
First Line : 840 S WOOD ST
Second Line : ROOM 345H MC 884
City : CHICAGO
State : IL
Zip : 60612-4325
Country : US
Telephone Number : 312-355-2035
Fax Number : 312-355-1916
Provider Business Practice Location Address
First Line : 840 S WOOD ST
Second Line : ROOM 163 MC 884
City : CHICAGO
State : IL
Zip : 60612-4325
Country : US
Telephone Number : 312-996-6887
Fax Number : 312-355-1916
Authorized Official
Title or Position : PHARMACY TECHNICIAN SPECIALIST
Name : MS. KRISTINE D VANKUIKEN
Credential :
Telephone Number : 312-355-2035
Provider Enumeration Date : 02/08/2007
Last Update Date : 03/07/2023

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Directions to “BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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