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NPI Code Detail

MEDICARE: ILLINOIS DEPARTMENT OF HUMAN

MEDICARE: ILLINOIS DEPARTMENT OF HUMAN
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
1333600000XPharmacy
23336L0003XLong Term Care Pharmacy054017313IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12023337OTHERPK

General Provider Information

NPI Number : 1457404667
Entity Type Code : Organization
Provider Name (Legal Business Name) : ILLINOIS DEPARTMENT OF HUMAN
Provider Business Mailing Address
First Line : 1401 W DUGDALE RD
Second Line :
City : WAUKEGAN
State : IL
Zip : 60085-6263
Country : US
Telephone Number : 847-249-0600
Fax Number : 847-249-0112
Provider Business Practice Location Address
First Line : 1401 W DUGDALE RD
Second Line :
City : WAUKEGAN
State : IL
Zip : 60085-6263
Country : US
Telephone Number : 847-249-0600
Fax Number : 847-249-0112
Authorized Official
Title or Position : CLINICAL PHARMACIST
Name : JENNIFER RYDEN
Credential : RPH
Telephone Number : 217-785-0906
Provider Enumeration Date : 01/19/2007
Last Update Date : 08/30/2016

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Directions to “ILLINOIS DEPARTMENT OF HUMAN ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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