Healthcare Provider Details

I. General information

NPI: 1023496742
Provider Name (Legal Business Name): ALEX KOWALSKI PHARM,D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2015
Last Update Date: 05/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2641 N SPRINGFIELD AVE
CHICAGO IL
60647-1030
US

IV. Provider business mailing address

2641 N. SPRINGFIELD AVE
CHICAGO IL
60647
US

V. Phone/Fax

Practice location:
  • Phone: 847-212-8297
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051.293601
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: