Provider Demographics
NPI:1922612928
Name:ILIESCU, VALENTINA (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:VALENTINA
Middle Name:
Last Name:ILIESCU
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2440 N LUNA AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60639-1335
Mailing Address - Country:US
Mailing Address - Phone:224-203-9286
Mailing Address - Fax:
Practice Address - Street 1:2440 N LUNA AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60639-1335
Practice Address - Country:US
Practice Address - Phone:224-203-9286
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-07
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051305686183500000X
IL49267646183700000X
IL049267646183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Yes183500000XPharmacy Service ProvidersPharmacist