Organization
BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS
Active
Other names
University of Illinois Wood Street PCC Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KRISTINE D VANKUIKEN (PHARMACY TECHNICIAN SPECIALIST)
(312) 355-2035
Entity
Organization
Contact information
Practice address
840 S WOOD ST, ROOM 163 MC 884, CHICAGO, IL 60612-4325
(312) 996-6887
(312) 355-1916
Mailing address
840 S WOOD ST, ROOM 345H MC 884, CHICAGO, IL 60612-4325
(312) 355-2035
(312) 355-1916
Taxonomy
Speciality
Code
Description
License number
State
3336C0002X
Clinic Pharmacy
Primary
054.017116
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
032-005923
STATE CONTROLLED SUBSTANC
IL
01
—
054017116
STATE LICENSE NUMBER
IL
01
—
1453428
NCPDP NUMBER
IL
Enumeration date
02/08/2007
Last updated
03/07/2023
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