Healthcare Provider Details

I. General information

NPI: 1417304882
Provider Name (Legal Business Name): LAUREN MELINA KUTA PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LAUREN MELINA LINDGREN PHARMD

II. Dates (important events)

Enumeration Date: 05/16/2016
Last Update Date: 05/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8730 W DEMPSTER ST
NILES IL
60714-5108
US

IV. Provider business mailing address

8730 W DEMPSTER ST
NILES IL
60714-5108
US

V. Phone/Fax

Practice location:
  • Phone: 847-296-3678
  • Fax:
Mailing address:
  • Phone: 847-296-3678
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051299111
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: