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General NPI Number Information
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NPI Number | 1942582523
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Entity Type | Individual
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Provider Name | AYANNA NKECHI GARDNER PHARMD
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Gender | Female
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Dates
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Enumeration Date | 09/09/2011
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Last Update Date | 09/09/2011
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Provider Practice Location Address
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Address Line | 20950 GOVERNORS HWY
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City | OLYMPIA FIELDS
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State | IL
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Zip | 60461-1039
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Country | US
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Telephone | 708-747-0121
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Fax |
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Provider Business Mailing Address
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Address Line | 16707 KIMBARK CT
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City | SOUTH HOLLAND
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State | IL
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Zip | 60473-3243
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Country | US
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Telephone | 708-646-5284
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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 | 051292144
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License Number State | IL
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