Healthcare Provider Details

I. General information

NPI: 1114527397
Provider Name (Legal Business Name): JANEL HORN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2020
Last Update Date: 11/07/2024
Certification Date: 11/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4005 167TH ST
COUNTRY CLUB HILLS IL
60478-2070
US

IV. Provider business mailing address

12311 S NAGLE AVE
PALOS HEIGHTS IL
60463-1723
US

V. Phone/Fax

Practice location:
  • Phone: 708-647-6738
  • Fax:
Mailing address:
  • Phone: 815-703-9608
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051294815
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: