Healthcare Provider Details

I. General information

NPI: 1720530751
Provider Name (Legal Business Name): CHARNELL HALL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2016
Last Update Date: 10/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 W POLK ST # 1200
CHICAGO IL
60612-3723
US

IV. Provider business mailing address

15900 S. CICERO BLDG F ROOM 23
OAK FOREST IL
60452
US

V. Phone/Fax

Practice location:
  • Phone: 708-633-4485
  • Fax:
Mailing address:
  • Phone: 708-633-4485
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number039658
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: