Provider Demographics
NPI:1083062202
Name:GRYS, JOLANTA
Entity Type:Individual
Prefix:
First Name:JOLANTA
Middle Name:
Last Name:GRYS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 S RANDALL RD
Mailing Address - Street 2:
Mailing Address - City:ALGONQUIN
Mailing Address - State:IL
Mailing Address - Zip Code:60102-9773
Mailing Address - Country:US
Mailing Address - Phone:847-854-8274
Mailing Address - Fax:847-854-5302
Practice Address - Street 1:107 S RANDALL RD
Practice Address - Street 2:
Practice Address - City:ALGONQUIN
Practice Address - State:IL
Practice Address - Zip Code:60102-9773
Practice Address - Country:US
Practice Address - Phone:847-854-8274
Practice Address - Fax:847-854-5302
Is Sole Proprietor?:No
Enumeration Date:2016-05-27
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.038010183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist