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NPI Code Detail

MEDICARE: JENNIFER TATIANA DIAZ RPH

MEDICARE: JENNIFER TATIANA DIAZ RPH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist051308481IL

General Provider Information

NPI Number : 1205771912
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER TATIANA DIAZ RPH
Provider Business Mailing Address
First Line : 5400 CARRIAGEWAY DR APT 108
Second Line :
City : ROLLING MEADOWS
State : IL
Zip : 60008-3937
Country : US
Telephone Number : 224-388-7788
Fax Number :
Provider Business Practice Location Address
First Line : 9800 IRVING PARK RD
Second Line :
City : SCHILLER PARK
State : IL
Zip : 60176-1448
Country : US
Telephone Number : 847-233-0576
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/20/2026
Last Update Date : 04/20/2026

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