Provider Demographics
NPI:1376679183
Name:JANOCIAK, JUSTINE D (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JUSTINE
Middle Name:D
Last Name:JANOCIAK
Suffix:
Gender:F
Credentials:PHARMD
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Mailing Address - Street 1:9831 S WESTERN AVE
Mailing Address - Street 2:ROOM 396
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60643-1791
Mailing Address - Country:US
Mailing Address - Phone:773-881-5632
Mailing Address - Fax:773-445-1285
Practice Address - Street 1:9831 S WESTERN AVE
Practice Address - Street 2:ROOM 396
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643-1791
Practice Address - Country:US
Practice Address - Phone:773-881-5632
Practice Address - Fax:773-445-1285
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL051-288901183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist