Healthcare Provider Details

I. General information

NPI: 1083203723
Provider Name (Legal Business Name): JEREMY STEVEN DELOR PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2021
Last Update Date: 02/03/2021
Certification Date: 02/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1740 W TAYLOR ST
CHICAGO IL
60612-7232
US

IV. Provider business mailing address

215 N ABERDEEN ST UNIT 307A
CHICAGO IL
60607-1628
US

V. Phone/Fax

Practice location:
  • Phone: 312-355-3031
  • Fax:
Mailing address:
  • Phone: 248-930-8521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051302461
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number051302461
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number10874003-1701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: