Provider Demographics
NPI:1083203723
Name:DELOR, JEREMY STEVEN (PHARMD)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:STEVEN
Last Name:DELOR
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 N ABERDEEN ST UNIT 307A
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-1628
Mailing Address - Country:US
Mailing Address - Phone:248-930-8521
Mailing Address - Fax:
Practice Address - Street 1:1740 W TAYLOR ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-7232
Practice Address - Country:US
Practice Address - Phone:312-355-3031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-17
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0513024611835P1200X, 183500000X
UT10874003-17011835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
No1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapyGroup - Multi-Specialty
No1835P2201XPharmacy Service ProvidersPharmacistAmbulatory CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL051302461OtherILLINOIS DEPARTMENT OF FINANCIAL AND PROFESSIONAL REGULATION