Healthcare Provider Details

I. General information

NPI: 1982028247
Provider Name (Legal Business Name): JOEL CHRISTOPHER REDDISH PHARM.D., BCPS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2014
Last Update Date: 02/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5145 N CALIFORNIA AVE
CHICAGO IL
60625-3661
US

IV. Provider business mailing address

5145 N CALIFORNIA AVE
CHICAGO IL
60625-3661
US

V. Phone/Fax

Practice location:
  • Phone: 773-989-3810
  • Fax:
Mailing address:
  • Phone: 773-989-3810
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number051293617
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number2004002637
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: