Healthcare Provider Details

I. General information

NPI: 1053499848
Provider Name (Legal Business Name): KATHRYN TORTORICE PHARM D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1ST AVE BLDG 37 ROOM 139 PBM(119D)
HINES IL
60141
US

IV. Provider business mailing address

1040 WENONAH AVE
OAK PARK IL
60304-1813
US

V. Phone/Fax

Practice location:
  • Phone: 708-786-7873
  • Fax:
Mailing address:
  • Phone: 708-786-7873
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: