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General NPI Number Information
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NPI Number | 1437407897
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Entity Type | Organization
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Legal Business Name | UNIVERSITY OF ILLINOIS AT CHICAGO
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Dates
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Enumeration Date | 08/16/2012
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Last Update Date | 08/16/2012
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Provider Practice Location Address
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Address Line | 833 S WOOD ST
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City | CHICAGO
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State | IL
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Zip | 60612-7229
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Country | US
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Telephone | 312-355-4081
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Fax |
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Provider Business Mailing Address
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Address Line | 833 S WOOD ST
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City | CHICAGO
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State | IL
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Zip | 60612-7229
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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 | CLINICAL PHARMACIST
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Name | JAY TRAN
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Credential | PHARMD
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Telephone | 312-355-4081
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | 051291932
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License Number State | IL
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