Healthcare Provider Details

I. General information

NPI: 1124728811
Provider Name (Legal Business Name): YISROEL ALLSWANG PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2023
Last Update Date: 03/09/2023
Certification Date: 03/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2551 W CERMAK RD
CHICAGO IL
60608-6192
US

IV. Provider business mailing address

2838 W MORSE AVE
CHICAGO IL
60645-2930
US

V. Phone/Fax

Practice location:
  • Phone: 773-475-4546
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051.294612
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: