Healthcare Provider Details

I. General information

NPI: 1033677570
Provider Name (Legal Business Name): RICHELE AUREA AMON ESCOBAR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2019
Last Update Date: 03/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3276 PRESTWICK LN
NORTHBROOK IL
60062-5123
US

IV. Provider business mailing address

3276 PRESTWICK LN
NORTHBROOK IL
60062-5123
US

V. Phone/Fax

Practice location:
  • Phone: 847-424-1369
  • Fax:
Mailing address:
  • Phone: 847-424-1369
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051-286330
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: