Healthcare Provider Details

I. General information

NPI: 1699378364
Provider Name (Legal Business Name): THU TRANG L VAN PHARMACIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2020
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11000 S CICERO AVE
OAK LAWN IL
60453-5504
US

IV. Provider business mailing address

8117 OAK PARK AVE
BURBANK IL
60459-1653
US

V. Phone/Fax

Practice location:
  • Phone: 708-346-0726
  • Fax:
Mailing address:
  • Phone: 708-527-8447
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number051.303354
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: