Healthcare Provider Details

I. General information

NPI: 1427871284
Provider Name (Legal Business Name): STEPHANIE GRALEWSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2024
Last Update Date: 10/31/2024
Certification Date: 10/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 S BROADWAY ST
COAL CITY IL
60416-1534
US

IV. Provider business mailing address

667 KAREN CT
CRETE IL
60417-2883
US

V. Phone/Fax

Practice location:
  • Phone: 815-634-0455
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051.305555
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: