Healthcare Provider Details

I. General information

NPI: 1114821535
Provider Name (Legal Business Name): CHRISTIE MARIE DENTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

833 S WOOD ST
CHICAGO IL
60612-7229
US

IV. Provider business mailing address

909 W WASHINGTON BLVD APT 403
CHICAGO IL
60607-2232
US

V. Phone/Fax

Practice location:
  • Phone: 312-355-4049
  • Fax:
Mailing address:
  • Phone: 419-953-2547
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051.303984
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: