Healthcare Provider Details

I. General information

NPI: 1881974434
Provider Name (Legal Business Name): AMY SKORNIAK PHARM. D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2011
Last Update Date: 08/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3336 11TH ST
ROCKFORD IL
61109-2206
US

IV. Provider business mailing address

3336 11TH ST
ROCKFORD IL
61109-2206
US

V. Phone/Fax

Practice location:
  • Phone: 815-394-0357
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051.292945
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: