Healthcare Provider Details

I. General information

NPI: 1962951756
Provider Name (Legal Business Name): DAWN PURNELL RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2016
Last Update Date: 09/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 EAST 50TH PLACE
CHICAGO IL
60615
US

IV. Provider business mailing address

430 E. 50TH PL
CHICAGO IL
60615
US

V. Phone/Fax

Practice location:
  • Phone: 312-572-2973
  • Fax: 312-572-2959
Mailing address:
  • Phone: 312-572-2973
  • Fax: 312-572-2959

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051039360
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: