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Individual

JAIMIE FANKHANEL

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
RPH

Contact information

Practice address
505 W ARMY TRAIL RD, BLOOMINGDALE, IL 60108-1391
(630) 351-3037
Mailing address
505 W ARMY TRAIL RD, BLOOMINGDALE, IL 60108-1391
(630) 351-3037

Taxonomy

Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
051-040895
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
183500000X
183500000X
IL
Enumeration date
03/13/2012
Last updated
03/13/2012
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