Healthcare Provider Details

I. General information

NPI: 1699637116
Provider Name (Legal Business Name): ANATASIA HOANG PHAM PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2025
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 N KENNEDY DR
KANKAKEE IL
60901-2033
US

IV. Provider business mailing address

302 CHESTERFIELD CT
BOURBONNAIS IL
60914-9653
US

V. Phone/Fax

Practice location:
  • Phone: 815-932-9615
  • Fax:
Mailing address:
  • Phone: 660-383-6392
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051.307706
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: