Healthcare Provider Details

I. General information

NPI: 1316920408
Provider Name (Legal Business Name): JILL E DUNMORE PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: JILL E DISCHLER PHARMD

II. Dates (important events)

Enumeration Date: 11/22/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4025 N SHERIDAN RD
CHICAGO IL
60613-2010
US

IV. Provider business mailing address

246 CLUBHOUSE ST
BOLINGBROOK IL
60490-2059
US

V. Phone/Fax

Practice location:
  • Phone: 773-528-8314
  • Fax:
Mailing address:
  • Phone: 630-759-4142
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number22259
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number12927-040
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: