Individual
CHUNKIT SO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
5415 S KILDARE AVE, CHICAGO, IL 60632-4629
(773) 971-8996
Mailing address
5415 S KILDARE AVE, CHICAGO, IL 60632-4629
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
051296016
IL
1835P1200X
Pharmacotherapy Pharmacist
Primary
051296016
IL
Other
Enumeration date
11/29/2016
Last updated
11/29/2016
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