Healthcare Provider Details

I. General information

NPI: 1336778919
Provider Name (Legal Business Name): ALISH KUPLY PHARMD.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2020
Last Update Date: 04/06/2020
Certification Date: 04/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2050 S FINLEY RD SUITE 20
LOMBARD IL
60148
US

IV. Provider business mailing address

OPTIONCARE.
LOMBARD IL
60025
US

V. Phone/Fax

Practice location:
  • Phone: 630-495-2899
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051.297947
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: