Healthcare Provider Details

I. General information

NPI: 1477323483
Provider Name (Legal Business Name): JESSICA GUZMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2024
Last Update Date: 01/07/2024
Certification Date: 01/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2744 N CALIFORNIA AVE
CHICAGO IL
60647-1736
US

IV. Provider business mailing address

2744 N CALIFORNIA AVE
CHICAGO IL
60647-1736
US

V. Phone/Fax

Practice location:
  • Phone: 773-342-2818
  • Fax:
Mailing address:
  • Phone: 773-342-2818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051.306072
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: