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Organization
ILLINOIS DEPARTMENT OF HUMAN
Active
Organization
ILLINOIS DEPARTMENT OF HUMAN
Active
Other names
Kiley Center
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER RYDEN RPH (CLINICAL PHARMACIST)
(217) 785-0906
Entity
Organization
Contact information
Practice address
1401 W DUGDALE RD, WAUKEGAN, IL 60085-6263
(847) 249-0600
(847) 249-0112
Mailing address
1401 W DUGDALE RD, WAUKEGAN, IL 60085-6263
(847) 249-0600
(847) 249-0112
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
Primary
054017313
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2023337
PK
—
Enumeration date
01/19/2007
Last updated
08/30/2016
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