Provider Demographics
NPI:1700452091
Name:WOJDYLA, KRYSTIAN J (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KRYSTIAN
Middle Name:J
Last Name:WOJDYLA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14930 W WHITNEY ST
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:IL
Mailing Address - Zip Code:60442-5047
Mailing Address - Country:US
Mailing Address - Phone:773-669-5797
Mailing Address - Fax:
Practice Address - Street 1:300 E WALNUT ST
Practice Address - Street 2:
Practice Address - City:WATSEKA
Practice Address - State:IL
Practice Address - Zip Code:60970-1359
Practice Address - Country:US
Practice Address - Phone:815-432-4172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-27
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.303877183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist