Healthcare Provider Details

I. General information

NPI: 1295656098
Provider Name (Legal Business Name): KATHLEEN JORDAN KANE PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2026
Last Update Date: 07/25/2026
Certification Date: 07/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5801 S DORCHESTER AVE APT 5B
CHICAGO IL
60637-1769
US

IV. Provider business mailing address

5801 S DORCHESTER AVE APT 5B
CHICAGO IL
60637-1769
US

V. Phone/Fax

Practice location:
  • Phone: 773-702-4566
  • Fax:
Mailing address:
  • Phone: 773-702-4566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835C0207X
TaxonomyCompounded Sterile Preparations Pharmacist
License Number051.297895
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: