Healthcare Provider Details

I. General information

NPI: 1326328030
Provider Name (Legal Business Name): NICOLE SALATA PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2011
Last Update Date: 10/31/2022
Certification Date: 10/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3311 N HALSTED ST
CHICAGO IL
60657-2412
US

IV. Provider business mailing address

PO BOX 7530
LIBERTYVILLE IL
60048-7530
US

V. Phone/Fax

Practice location:
  • Phone: 773-435-9583
  • Fax:
Mailing address:
  • Phone: 847-650-4540
  • Fax: 847-546-8048

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number20069-40
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051.294518
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: