Healthcare Provider Details

I. General information

NPI: 1134218183
Provider Name (Legal Business Name): ANN M KUCHTA PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

833 S WOOD ST ROOM 164 M/C 883
CHICAGO IL
60612-7229
US

IV. Provider business mailing address

731 61ST ST
COUNTRYSIDE IL
60525-3945
US

V. Phone/Fax

Practice location:
  • Phone: 312-996-6686
  • Fax: 312-996-0369
Mailing address:
  • Phone: 708-354-2517
  • Fax: 708-352-0591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: