Healthcare Provider Details

I. General information

NPI: 1457297392
Provider Name (Legal Business Name): DAMIAN PACIOREK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2026
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34344 N US HIGHWAY 45
THIRD LAKE IL
60030-4031
US

IV. Provider business mailing address

1496 CHIPPEWA TRL
WHEELING IL
60090-5114
US

V. Phone/Fax

Practice location:
  • Phone: 847-543-5441
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051308456
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: