Healthcare Provider Details

I. General information

NPI: 1093096307
Provider Name (Legal Business Name): DR. ANNA CIUKAJ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2011
Last Update Date: 08/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4001 W ALGONQUIN RD
ALGONQUIN IL
60102-9401
US

IV. Provider business mailing address

435 E JUNIPER DR
PALATINE IL
60074-3773
US

V. Phone/Fax

Practice location:
  • Phone: 224-569-2582
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051293698
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS45418
License Number StateFL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: