Healthcare Provider Details

I. General information

NPI: 1467176560
Provider Name (Legal Business Name): JILL PLOEGMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2022
Last Update Date: 10/03/2022
Certification Date: 10/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 S COUNTY FARM RD
WHEATON IL
60187-4529
US

IV. Provider business mailing address

601 S COUNTY FARM RD
WHEATON IL
60187-4529
US

V. Phone/Fax

Practice location:
  • Phone: 630-510-1685
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051.289251
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: