Individual
MRS. JOHANNA VISA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5516 N CLARK ST, CHICAGO, IL 60640-1214
(773) 784-7348
(773) 784-1408
Mailing address
5532 CLARK STREET, CHICAGO, IL 60640
(773) 784-7348
(773) 784-1408
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
051297571
IL
Other
Enumeration date
06/09/2016
Last updated
06/09/2016
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