Healthcare Provider Details

I. General information

NPI: 1922378611
Provider Name (Legal Business Name): MR. DAVID ORELLANA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2012
Last Update Date: 01/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 E SAUK TRL
SAUK VILLAGE IL
60411-5262
US

IV. Provider business mailing address

9724 S MARQUETTE AVE
CHICAGO IL
60617-4946
US

V. Phone/Fax

Practice location:
  • Phone: 708-757-6906
  • Fax: 708-757-7867
Mailing address:
  • Phone: 773-933-9491
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051-040527
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: