Individual
MR. EDMUND VINCENT MIRECKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RPH
Contact information
Practice address
4710 S WESTERN AVE, CHICAGO, IL 60609-4060
(773) 579-0366
(773) 579-0427
Mailing address
161 N PARK RD, LA GRANGE, IL 60525-1854
(708) 354-4335
(773) 579-0427
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
—
IL
Other
Enumeration date
08/31/2006
Last updated
07/08/2007
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