Healthcare Provider Details

I. General information

NPI: 1205771912
Provider Name (Legal Business Name): JENNIFER TATIANA DIAZ RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2026
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9800 IRVING PARK RD
SCHILLER PARK IL
60176-1448
US

IV. Provider business mailing address

5400 CARRIAGEWAY DR APT 108
ROLLING MEADOWS IL
60008-3937
US

V. Phone/Fax

Practice location:
  • Phone: 847-233-0576
  • Fax:
Mailing address:
  • Phone: 224-388-7788
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051308481
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: