Provider Demographics
NPI:1073865416
Name:KRUPA, RENE (RPH)
Entity Type:Individual
Prefix:
First Name:RENE
Middle Name:
Last Name:KRUPA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1329 S YALE AVE
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-3418
Mailing Address - Country:US
Mailing Address - Phone:847-577-6784
Mailing Address - Fax:
Practice Address - Street 1:1329 S YALE AVE
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-3418
Practice Address - Country:US
Practice Address - Phone:847-577-6784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-09
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.031047183500000X
LAPST.019634183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist