Healthcare Provider Details

I. General information

NPI: 1255255634
Provider Name (Legal Business Name): KRISTIN CULLINAN RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
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

1512 FOREST AVE
RIVER FOREST IL
60305-1004
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number051290801
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: