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Individual

KELLY DECANIO

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
1435 LAKE COOK RD, DEERFIELD, IL 60015-5213
(847) 687-9974
Mailing address
5 BRENTWOOD DR, HAWTHORN WOODS, IL 60047-7402

Taxonomy

Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
051298728
IL

Other

Enumeration date
03/07/2018
Last updated
03/07/2018
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