Provider Demographics
NPI:1669753984
Name:MCKIEL, JOAN R (RPH, PHARMD)
Entity type:Individual
Prefix:MS
First Name:JOAN
Middle Name:R
Last Name:MCKIEL
Suffix:
Gender:F
Credentials:RPH, PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1086 ELLSWORTH DR
Mailing Address - Street 2:
Mailing Address - City:GRAYSLAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60030-3367
Mailing Address - Country:US
Mailing Address - Phone:847-986-6017
Mailing Address - Fax:
Practice Address - Street 1:1086 ELLSWORTH DR
Practice Address - Street 2:
Practice Address - City:GRAYSLAKE
Practice Address - State:IL
Practice Address - Zip Code:60030-3367
Practice Address - Country:US
Practice Address - Phone:847-986-6017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-31
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH 00015330183500000X
IL051.286877183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist