Provider Demographics
NPI:1790380707
Name:WARCHOLEK, ILONA
Entity Type:Individual
Prefix:
First Name:ILONA
Middle Name:
Last Name:WARCHOLEK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 S NORTHWEST HWY
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-4607
Mailing Address - Country:US
Mailing Address - Phone:847-381-4105
Mailing Address - Fax:847-381-6119
Practice Address - Street 1:101 S NORTHWEST HWY
Practice Address - Street 2:
Practice Address - City:BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-4607
Practice Address - Country:US
Practice Address - Phone:847-381-4105
Practice Address - Fax:847-381-6119
Is Sole Proprietor?:No
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.288209183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist