Individual
MS. CHAUNTA NICOLE WILLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CPHT
Contact information
Practice address
3753 S COTTAGE GROVE AVE, CHICAGO, IL 60653-1407
(773) 451-0712
(773) 451-0714
Mailing address
3753 S COTTAGE GROVE AVE, CHICAGO, IL 60653-1407
(773) 451-0712
(773) 451-0714
Taxonomy
Speciality
Code
Description
License number
State
183700000X
Pharmacy Technician
Primary
049168746
IL
Other
Enumeration date
08/22/2013
Last updated
08/22/2013
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