Provider Demographics
NPI:1952866923
Name:QUIJANO, THERESE
Entity Type:Individual
Prefix:
First Name:THERESE
Middle Name:
Last Name:QUIJANO
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 1:1515 SHERIDAN RD
Mailing Address - Street 2:
Mailing Address - City:WILMETTE
Mailing Address - State:IL
Mailing Address - Zip Code:60091-1822
Mailing Address - Country:US
Mailing Address - Phone:847-251-6223
Mailing Address - Fax:
Practice Address - Street 1:1515 SHERIDAN RD
Practice Address - Street 2:
Practice Address - City:WILMETTE
Practice Address - State:IL
Practice Address - Zip Code:60091-1822
Practice Address - Country:US
Practice Address - Phone:847-251-6223
Practice Address - Fax:847-251-6223
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-04
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.302965183500000X
CA80078183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist