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General NPI Number Information
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NPI Number | 1205771912
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Entity Type | Individual
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Provider Name | JENNIFER TATIANA DIAZ RPH
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Gender | Female
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Dates
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Enumeration Date | 04/20/2026
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Last Update Date | 04/20/2026
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Provider Practice Location Address
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Address Line | 9800 IRVING PARK RD
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City | SCHILLER PARK
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State | IL
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Zip | 60176-1448
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Country | US
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Telephone | 847-233-0576
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Fax |
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Provider Business Mailing Address
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Address Line | 5400 CARRIAGEWAY DR APT 108
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City | ROLLING MEADOWS
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State | IL
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Zip | 60008-3937
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Country | US
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Telephone | 224-388-7788
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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 | 051308481
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License Number State | IL
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