Organization
ILLINOIS DEPARTMENT OF HUMAN
Active
Other names
Kiley Center
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER RYDEN RPH (CLINICAL PHARMACIST)
(217) 785-0906
Entity
Organization
Contact information
Practice address
1401 W DUGDALE RD, WAUKEGAN, IL 60085-6263
(847) 249-0600
(847) 249-0112
Mailing address
1401 W DUGDALE RD, WAUKEGAN, IL 60085-6263
(847) 249-0600
(847) 249-0112
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
Primary
054017313
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2023337
PK
—
Enumeration date
01/19/2007
Last updated
08/30/2016
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