Individual
DMITRIY KHUTORYANSKIY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4051 N LINCOLN AVE, CHICAGO, IL 60618-3009
(773) 871-2611
Mailing address
4051 N LINCOLN AVE, CHICAGO, IL 60618-3009
(773) 871-2611
(773) 871-3604
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
051292529
IL
333600000X
Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1902847874
—
IL
Enumeration date
12/28/2020
Last updated
12/28/2020
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