Healthcare Provider Details

I. General information

NPI: 1457947889
Provider Name (Legal Business Name): LAUREN OLIVERI PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2020
Last Update Date: 12/20/2020
Certification Date: 12/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1740 W TAYLOR ST
CHICAGO IL
60612-7232
US

IV. Provider business mailing address

833 S WOOD ST # MC886
CHICAGO IL
60612-7229
US

V. Phone/Fax

Practice location:
  • Phone: 312-996-2021
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number051293680
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: