Healthcare Provider Details

I. General information

NPI: 1245194596
Provider Name (Legal Business Name): ALYSSA WOODALL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2025
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

933 W VAN BUREN ST APT 424
CHICAGO IL
60607-3583
US

IV. Provider business mailing address

933 W VAN BUREN ST APT 424
CHICAGO IL
60607-3583
US

V. Phone/Fax

Practice location:
  • Phone: 519-981-2858
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051.307144
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: