Healthcare Provider Details

I. General information

NPI: 1194657627
Provider Name (Legal Business Name): AUSTIN JAMES IGNATOVICH PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 05/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 E HURON ST
CHICAGO IL
60611-2908
US

IV. Provider business mailing address

441 E ERIE ST APT 2403
CHICAGO IL
60611-7124
US

V. Phone/Fax

Practice location:
  • Phone: 269-986-5384
  • Fax:
Mailing address:
  • Phone: 269-986-5384
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051307241
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: