Healthcare Provider Details

I. General information

NPI: 1083544555
Provider Name (Legal Business Name): ILLINOIS DEPARTMENT OF HUMAN SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 N OAK PARK AVE
CHICAGO IL
60634-1417
US

IV. Provider business mailing address

4200 N OAK PARK AVE
CHICAGO IL
60634-1417
US

V. Phone/Fax

Practice location:
  • Phone: 773-794-4316
  • Fax: 773-794-3877
Mailing address:
  • Phone: 217-782-1384
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: NORMA HOLTZ
Title or Position: CLINICAL PHARMACIST
Credential: RPH
Phone: 217-782-1384