Healthcare Provider Details

I. General information

NPI: 1083539761
Provider Name (Legal Business Name): ALEXS NICOLE COFFEE PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1411 S MICHIGAN AVE
CHICAGO IL
60605-2810
US

IV. Provider business mailing address

9501 S KING DR
CHICAGO IL
60628-1598
US

V. Phone/Fax

Practice location:
  • Phone: 312-454-2700
  • Fax:
Mailing address:
  • Phone: 773-821-2612
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number051305907
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: