Healthcare Provider Details

I. General information

NPI: 1962850578
Provider Name (Legal Business Name): JILL WALKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2016
Last Update Date: 05/25/2016
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: 815-577-2613
  • Fax:
Mailing address:
  • Phone: 815-577-2613
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberIL051285879
License Number StateIL

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: