=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144500687
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LAURA J KWON PHARMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/27/2011
-----------------------------------------------------
Last Update Date | 07/17/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1 N WAUKEGAN RD AP5
-----------------------------------------------------
City | NORTH CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60064
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-222-6885
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 182 COLONIAL DR
-----------------------------------------------------
City | VERNON HILLS
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60061-3815
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-951-6939
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 051.290858
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------