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NPI Code Detail

MEDICARE: JADE DENAE HUIZENGA PHARMD, B.S., B.A.

MEDICARE: JADE DENAE HUIZENGA PHARMD, B.S., B.A.
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
1183500000XPharmacist051.291765IL

General Provider Information

NPI Number : 1801181839
Entity Type Code : Individual
Provider Name (Legal Business Name) : JADE DENAE HUIZENGA PHARMD, B.S., B.A.
Provider Business Mailing Address
First Line : 4120 W 95TH ST
Second Line : TARGET-2087
City : OAK LAWN
State : IL
Zip : 60453-2675
Country : US
Telephone Number : 708-741-4070
Fax Number : 708-741-4069
Provider Business Practice Location Address
First Line : 4120 W 95TH ST
Second Line : TARGET-2087
City : OAK LAWN
State : IL
Zip : 60453-2675
Country : US
Telephone Number : 708-741-4070
Fax Number : 708-741-4069
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/17/2011
Last Update Date : 06/17/2011

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