Healthcare Provider Details

I. General information

NPI: 1972884922
Provider Name (Legal Business Name): TANYA UDCHIK RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2011
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 NORTHWEST HWY
CRYSTAL LAKE IL
60014-7951
US

IV. Provider business mailing address

105 NORTHWEST HWY
CRYSTAL LAKE IL
60014-7951
US

V. Phone/Fax

Practice location:
  • Phone: 815-261-4733
  • Fax: 815-261-4736
Mailing address:
  • Phone: 815-261-4733
  • Fax: 815-261-4736

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number051287355
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: