Healthcare Provider Details

I. General information

NPI: 1265366793
Provider Name (Legal Business Name): WEN W JIANG PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4822 S COTTAGE GROVE AVE
CHICAGO IL
60615-1614
US

IV. Provider business mailing address

4822 S COTTAGE GROVE AVE ONCOLOGY PHARMACY SUITE 5-500
CHICAGO IL
60615-1614
US

V. Phone/Fax

Practice location:
  • Phone: 312-921-1150
  • Fax: 312-921-1201
Mailing address:
  • Phone: 312-921-1150
  • Fax: 312-921-1201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number051.293867
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: