Healthcare Provider Details

I. General information

NPI: 1720237555
Provider Name (Legal Business Name): KRISTEN M RICHARDSON PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2008
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 RIVERSTONE PKWY
KANKAKEE IL
60901-7207
US

IV. Provider business mailing address

8700 S CICERO AVE
OAK LAWN IL
60453-1372
US

V. Phone/Fax

Practice location:
  • Phone: 815-802-3166
  • Fax:
Mailing address:
  • Phone: 708-422-0471
  • Fax: 708-424-7058

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051291762
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: