Provider Demographics
NPI:1568005346
Name:RICHARDSON, JILL (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:
Last Name:RICHARDSON
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 1:15208 GINGER CREEK LN
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60467-7301
Mailing Address - Country:US
Mailing Address - Phone:708-822-8720
Mailing Address - Fax:
Practice Address - Street 1:15208 GINGER CREEK LN
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60467-7301
Practice Address - Country:US
Practice Address - Phone:708-822-8720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-23
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051289402183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist