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General NPI Number Information
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NPI Number | 1154248045
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Entity Type | Individual
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Provider Name | JONAH KOELLING
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Gender | Male
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Dates
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Enumeration Date | 07/01/2026
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Last Update Date | 07/01/2026
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Provider Practice Location Address
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Address Line | 5101 WILLOW SPRINGS RD
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City | LA GRANGE
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State | IL
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Zip | 60525-2600
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Country | US
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Telephone | 708-245-3988
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Fax |
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Provider Business Mailing Address
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Address Line | 3047 N OAKLEY AVE
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City | CHICAGO
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State | IL
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Zip | 60618-7997
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Country | US
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Telephone |
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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 | 1835P1200X
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Taxonomy Name | Pharmacotherapy Pharmacist
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License Number | 051.294767
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License Number State | IL
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