Healthcare Provider Details

I. General information

NPI: 1629390190
Provider Name (Legal Business Name): JAMES JOUNG PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2010
Last Update Date: 02/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 W ROOSEVELT RD
CHICAGO IL
60624-4225
US

IV. Provider business mailing address

3600 W ROOSEVELT RD
CHICAGO IL
60624-4225
US

V. Phone/Fax

Practice location:
  • Phone: 773-638-3600
  • Fax: 773-762-4527
Mailing address:
  • Phone: 773-638-3600
  • Fax: 773-762-4527

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051-034089
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: