Healthcare Provider Details

I. General information

NPI: 1104961317
Provider Name (Legal Business Name): CHERYL HAGLUND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2025 S CHICAGO ST
JOLIET IL
60436-3172
US

IV. Provider business mailing address

1809 DALLAS PL
JOLIET IL
60433-3135
US

V. Phone/Fax

Practice location:
  • Phone: 815-723-0300
  • Fax: 815-725-7500
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number04912217
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: