Provider Demographics
NPI:1316560485
Name:QUIROS, GORDANA (PHARMD)
Entity Type:Individual
Prefix:
First Name:GORDANA
Middle Name:
Last Name:QUIROS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2884 FALLING WATERS DR
Mailing Address - Street 2:
Mailing Address - City:LINDENHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60046-6775
Mailing Address - Country:US
Mailing Address - Phone:847-917-1790
Mailing Address - Fax:
Practice Address - Street 1:2884 FALLING WATERS DR
Practice Address - Street 2:
Practice Address - City:LINDENHURST
Practice Address - State:IL
Practice Address - Zip Code:60046-6775
Practice Address - Country:US
Practice Address - Phone:847-917-1790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-24
Last Update Date:2020-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.298812183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist