Healthcare Provider Details

I. General information

NPI: 1487227898
Provider Name (Legal Business Name): KS PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2021
Last Update Date: 06/25/2024
Certification Date: 06/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2333 N HARLEM AVE STE 100
CHICAGO IL
60707-2718
US

IV. Provider business mailing address

645 N KINGSBURY ST APT 1804
CHICAGO IL
60654-6873
US

V. Phone/Fax

Practice location:
  • Phone: 312-319-2729
  • Fax:
Mailing address:
  • Phone: 847-610-0144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DR. KAROLINA MACULEWICZ
Title or Position: PHARMACIST IN CHARGE
Credential: PHARMD
Phone: 312-319-2729