Organization
5 CS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TIAJUANA DIXON (OWNER)
(708) 704-7570
Entity
Organization
Contact information
Practice address
10830 S HALSTED ST, CHICAGO, IL 60628
(773) 468-0223
Mailing address
10830 S HALSTED ST, CHICAGO, IL 60628-3126
(773) 468-0223
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
051.287455
IL
Other
Enumeration date
09/06/2017
Last updated
07/21/2022
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