Healthcare Provider Details

I. General information

NPI: 1588082598
Provider Name (Legal Business Name): LENGLILY KRUY PHARM D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2014
Last Update Date: 04/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5145 NORTH CALIFORNIA AVE
CHICAGO IL
60625
US

IV. Provider business mailing address

5145 NORTH CALIFORNIA AVE
CHICAGO IL
60625
US

V. Phone/Fax

Practice location:
  • Phone: 773-989-3810
  • Fax:
Mailing address:
  • Phone: 773-878-8200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051294539
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: