Provider Demographics
NPI:1669753646
Name:WILEWSKI, DENNIS WALTER (PHARMACIST)
Entity type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:WALTER
Last Name:WILEWSKI
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5753 N CANFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631-2206
Mailing Address - Country:US
Mailing Address - Phone:773-631-2851
Mailing Address - Fax:773-631-3864
Practice Address - Street 1:5753 N CANFIELD AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631-2206
Practice Address - Country:US
Practice Address - Phone:773-631-2851
Practice Address - Fax:773-631-3864
Is Sole Proprietor?:No
Enumeration Date:2011-09-02
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051-28886183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist