Provider Demographics
NPI:1346525680
Name:MOLIK, KRYSTYNA B (RPH)
Entity Type:Individual
Prefix:MRS
First Name:KRYSTYNA
Middle Name:B
Last Name:MOLIK
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 1:305 S EASTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:IL
Mailing Address - Zip Code:60098-4626
Mailing Address - Country:US
Mailing Address - Phone:815-338-7880
Mailing Address - Fax:815-338-1629
Practice Address - Street 1:305 S EASTWOOD DR
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:IL
Practice Address - Zip Code:60098-4626
Practice Address - Country:US
Practice Address - Phone:815-338-7880
Practice Address - Fax:815-338-1629
Is Sole Proprietor?:No
Enumeration Date:2011-10-19
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.289122183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist