Healthcare Provider Details

I. General information

NPI: 1780280339
Provider Name (Legal Business Name): MAGDALENA WOJCIKIEWICZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2020
Last Update Date: 12/09/2020
Certification Date: 12/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3615 N CENTRAL AVE
CHICAGO IL
60634-2753
US

IV. Provider business mailing address

3615 N CENTRAL AVE
CHICAGO IL
60634-2753
US

V. Phone/Fax

Practice location:
  • Phone: 773-283-2355
  • Fax:
Mailing address:
  • Phone: 773-283-2355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051.298541
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: