Provider Demographics
NPI:1457439259
Name:WILSAK, NANCY JO (RPH)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:JO
Last Name:WILSAK
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 1:6734 BLACKBURN PL
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60516-3643
Mailing Address - Country:US
Mailing Address - Phone:630-515-0673
Mailing Address - Fax:
Practice Address - Street 1:1ST AVE-1 BLK N OF CERMAK RD
Practice Address - Street 2:BLDG 37 ROOM139
Practice Address - City:HINES
Practice Address - State:IL
Practice Address - Zip Code:60141
Practice Address - Country:US
Practice Address - Phone:707-896-7869
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist