Individual
CRYSTAL FATAMEH ELUSTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
7939 S TRIPP AVE, CHICAGO, IL 60652-2234
(773) 735-0142
Mailing address
7939 S TRIPP AVE, CHICAGO, IL 60652-2234
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
051306025
IL
Other
Enumeration date
12/11/2023
Last updated
12/11/2023
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