Healthcare Provider Details

I. General information

NPI: 1629637160
Provider Name (Legal Business Name): MIRIAM ARNOLD PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MIRIAM RAJAB

II. Dates (important events)

Enumeration Date: 06/09/2019
Last Update Date: 08/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13460 S ROUTE 59
PLAINFIELD IL
60585-5270
US

IV. Provider business mailing address

13460 S ROUTE 59
PLAINFIELD IL
60585-5270
US

V. Phone/Fax

Practice location:
  • Phone: 815-577-2605
  • Fax:
Mailing address:
  • Phone: 815-577-2605
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051.302387
License Number StateIL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier051.302387
Identifier TypeOTHER
Identifier StateIL
Identifier IssuerILDFPR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: