Healthcare Provider Details

I. General information

NPI: 1922497981
Provider Name (Legal Business Name): JOEL VICTOR OHRLUND PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2015
Last Update Date: 01/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5625 N RIDGE AVE
CHICAGO IL
60660-3434
US

IV. Provider business mailing address

107 MOHAWK TRL
BUFFALO GROVE IL
60089-3523
US

V. Phone/Fax

Practice location:
  • Phone: 773-989-7546
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051.298303
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: