Healthcare Provider Details

I. General information

NPI: 1750791588
Provider Name (Legal Business Name): MILROSE HARTING
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2014
Last Update Date: 05/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 S WEBER RD
ROMEOVILLE IL
60446-4947
US

IV. Provider business mailing address

1890 LAKE SHORE DR
ROMEOVILLE IL
60446-3945
US

V. Phone/Fax

Practice location:
  • Phone: 815-293-0858
  • Fax:
Mailing address:
  • Phone: 815-886-1562
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051-038932
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: