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General NPI Number Information
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NPI Number | 1043813231
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Entity Type | Individual
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Provider Name | BETTY KHILEVICH
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Gender | Female
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Dates
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Enumeration Date | 11/19/2020
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Last Update Date | 11/19/2020
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Provider Practice Location Address
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Address Line | 3200 N CLARK ST
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City | CHICAGO
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State | IL
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Zip | 60657-1602
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Country | US
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Telephone | 773-248-2841
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Fax |
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Provider Business Mailing Address
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Address Line | 818 S RIDGE AVE
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City | ARLINGTON HEIGHTS
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State | IL
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Zip | 60005-2334
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Country | US
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Telephone | 847-606-8485
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 051301177
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License Number State | IL
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