Organization
BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS
Active
Other names
University of Illinois Mile Square Neighborhood Clinic Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KRISTINE D VANKUIKEN CPHT (PHARMACY TECHNICIAN SPECIALIST)
(312) 355-2035
Entity
Organization
Contact information
Practice address
1220 S WOOD ST, ROOM 1045 MC 884, CHICAGO, IL 60608-1202
(312) 413-1767
(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
054.017118
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
032-005960
STATE CONTROLLED SUBSTANC
IL
01
—
054-017118
STATE PHARMACY LICENSE
IL
01
—
093-010041
STATE LICENSE NUMBER
IL
01
—
1418006
NCPDP NUMBER
ID
Enumeration date
02/08/2007
Last updated
03/07/2023
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