Healthcare Provider Details

I. General information

NPI: 1558265512
Provider Name (Legal Business Name): EMILIO JOSE EDEMNI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: EMILIO EDEMNI

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1711 W CAMPBELL ST
ARLINGTON HEIGHTS IL
60005-1517
US

IV. Provider business mailing address

1711 W CAMPBELL ST
ARLINGTON HEIGHTS IL
60005-1517
US

V. Phone/Fax

Practice location:
  • Phone: 847-577-7099
  • Fax:
Mailing address:
  • Phone: 847-577-7099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051.309618
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: