Healthcare Provider Details

I. General information

NPI: 1073960332
Provider Name (Legal Business Name): MICHAEL TRNKA PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2016
Last Update Date: 05/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2164 BLOOMINGDALE RD
GLENDALE HEIGHTS IL
60139-1699
US

IV. Provider business mailing address

2164 BLOOMINGDALE RD
GLENDALE HEIGHTS IL
60139-1699
US

V. Phone/Fax

Practice location:
  • Phone: 163-098-0430
  • Fax: 163-098-0430
Mailing address:
  • Phone: 163-098-0430
  • Fax: 163-098-0430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051.291610
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: