Healthcare Provider Details

I. General information

NPI: 1023382520
Provider Name (Legal Business Name): JILL MARIE DRURY PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/29/2012
Last Update Date: 02/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

474 N LAKE SHORE DR SUITE 3407
CHICAGO IL
60611-3400
US

IV. Provider business mailing address

474 N LAKE SHORE DR SUITE 3407
CHICAGO IL
60611-3400
US

V. Phone/Fax

Practice location:
  • Phone: 312-618-7465
  • Fax: 952-352-6682
Mailing address:
  • Phone: 312-618-7465
  • Fax: 952-352-6682

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number051292434
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License Number14884-40
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: