Provider Demographics
NPI:1649874561
Name:TADROS, KIMBERLY KRUPA (PHARMD)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:KRUPA
Last Name:TADROS
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:VAMC OUTPATIENT PHARMACY
Mailing Address - Street 2:820 S DAMEN AVE
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612
Mailing Address - Country:US
Mailing Address - Phone:312-569-7110
Mailing Address - Fax:
Practice Address - Street 1:VAMC OUTPATIENT PHARMACY
Practice Address - Street 2:820 S DAMEN AVE
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612
Practice Address - Country:US
Practice Address - Phone:312-569-7110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-23
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS42580183500000X
IL051293121183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist