Provider Demographics
NPI:1407431570
Name:JOSE, JOSLYN MARY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JOSLYN
Middle Name:MARY
Last Name:JOSE
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 1:7443 KORBEL DR
Mailing Address - Street 2:
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-5130
Mailing Address - Country:US
Mailing Address - Phone:847-271-7161
Mailing Address - Fax:
Practice Address - Street 1:335 N MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:VERNON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60061-1561
Practice Address - Country:US
Practice Address - Phone:847-955-9254
Practice Address - Fax:847-955-9258
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-10
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051303570183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist