Healthcare Provider Details

I. General information

NPI: 1669391322
Provider Name (Legal Business Name): IRIS GALICIA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2227 S CHRISTIANA AVE
CHICAGO IL
60623-3215
US

IV. Provider business mailing address

2227 S CHRISTIANA AVE
CHICAGO IL
60623-3215
US

V. Phone/Fax

Practice location:
  • Phone: 708-556-1682
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number049.321058
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: