Healthcare Provider Details

I. General information

NPI: 1740898444
Provider Name (Legal Business Name): NATHAN SKORODIN PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2020
Last Update Date: 07/19/2020
Certification Date: 07/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 MCCLINTOCK DR STE 201
BURR RIDGE IL
60527-0872
US

IV. Provider business mailing address

901 MCCLINTOCK DR STE 201
BURR RIDGE IL
60527-0872
US

V. Phone/Fax

Practice location:
  • Phone: 630-655-6750
  • Fax:
Mailing address:
  • Phone: 630-655-6750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051286060
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: