Healthcare Provider Details

I. General information

NPI: 1982208062
Provider Name (Legal Business Name): JONATHAN ANTHONY KLIMEK PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2020
Last Update Date: 03/24/2022
Certification Date: 03/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 N COUNTY FARM RD
WHEATON IL
60187-3908
US

IV. Provider business mailing address

93 S PINE ST
GENEVA IL
60134-1918
US

V. Phone/Fax

Practice location:
  • Phone: 630-784-4275
  • Fax:
Mailing address:
  • Phone: 708-280-6284
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051.294039
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: