Healthcare Provider Details

I. General information

NPI: 1295102580
Provider Name (Legal Business Name): LAURA RYCRAFT PHARMD.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2015
Last Update Date: 08/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3626 TOUHY AVE
SKOKIE IL
60076-3943
US

IV. Provider business mailing address

3626 TOUHY AVE
SKOKIE IL
60076-3943
US

V. Phone/Fax

Practice location:
  • Phone: 847-983-1411
  • Fax: 847-983-1412
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051291037
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: