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General NPI Number Information
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NPI Number | 1902282916
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Entity Type | Individual
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Provider Name | JOANNA BODNAR PHARMD
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Gender | Female
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Dates
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Enumeration Date | 08/03/2015
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Last Update Date | 01/21/2022
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Provider Practice Location Address
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Address Line | 1725 W HARRISON ST STE 1059
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City | CHICAGO
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State | IL
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Zip | 60612-3841
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Country | US
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Telephone | 708-660-3727
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Fax |
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Provider Business Mailing Address
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Address Line | 245 BURLINGTON AVE APT 312
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City | CLARENDON HILLS
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State | IL
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Zip | 60514-1198
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Country | US
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Telephone | 815-341-2056
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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 | 051.298702
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License Number State | IL
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