Individual
GRANT CONKLIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
10639 S CICERO AVE, OAK LAWN, IL 60453-5269
(709) 424-3594
Mailing address
632 W ROSCOE ST APT 1N, CHICAGO, IL 60657-2945
(815) 409-6405
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
051305021
IL
Other
Enumeration date
09/19/2022
Last updated
09/19/2022
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