Healthcare Provider Details

I. General information

NPI: 1598046278
Provider Name (Legal Business Name): ADAM KUPIEC PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2011
Last Update Date: 09/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4150 OLD RIVER RD
SCHILLER PARK IL
60176-2281
US

IV. Provider business mailing address

4150 OLD RIVER RD
SCHILLER PARK IL
60176-2281
US

V. Phone/Fax

Practice location:
  • Phone: 773-625-4549
  • Fax: 773-625-4549
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051289922
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: