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General NPI Number Information
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NPI Number | 1790826352
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Entity Type | Organization
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Legal Business Name | BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS
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Dates
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Enumeration Date | 02/08/2007
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 1220 S WOOD ST ROOM 1045 MC 884
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City | CHICAGO
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State | IL
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Zip | 60608-1202
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Country | US
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Telephone | 312-413-1767
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Fax | 312-355-1916
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Provider Business Mailing Address
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Address Line | 840 S WOOD ST ROOM 345H MC 884
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City | CHICAGO
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State | IL
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Zip | 60612-4325
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Country | US
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Telephone | 312-355-2035
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Fax | 312-355-1916
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Authorized Official
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Title or Position | PHARMACY TECHNICIAN SPECIALIST
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Name | MS. KRISTINE D VANKUIKEN
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Credential | CPHT
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Telephone | 312-355-2035
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0002X
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Taxonomy Name | Clinic Pharmacy
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License Number | 054.017118
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License Number State | IL
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