Provider Demographics
NPI:1801181839
Name:HUIZENGA, JADE DENAE (PHARMD, BS, BA)
Entity Type:Individual
Prefix:
First Name:JADE
Middle Name:DENAE
Last Name:HUIZENGA
Suffix:
Gender:F
Credentials:PHARMD, BS, BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4120 W 95TH ST
Mailing Address - Street 2:TARGET-2087
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-2675
Mailing Address - Country:US
Mailing Address - Phone:708-741-4070
Mailing Address - Fax:708-741-4069
Practice Address - Street 1:4120 W 95TH ST
Practice Address - Street 2:TARGET-2087
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2675
Practice Address - Country:US
Practice Address - Phone:708-741-4070
Practice Address - Fax:708-741-4069
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-17
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.291765183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist