Healthcare Provider Details

I. General information

NPI: 1790038669
Provider Name (Legal Business Name): JOANNA URBAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2012
Last Update Date: 12/06/2024
Certification Date: 12/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8400 W NORTH AVE
MELROSE PARK IL
60160-1607
US

IV. Provider business mailing address

1713 W PHEASANT TRL
MT PROSPECT IL
60056-4554
US

V. Phone/Fax

Practice location:
  • Phone: 708-397-2905
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051296216
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: