Provider Demographics
NPI:1700542792
Name:DYMALA, KAMILA N/A
Entity Type:Individual
Prefix:
First Name:KAMILA
Middle Name:N/A
Last Name:DYMALA
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 1:5400 WALNUT AVE UNIT 208
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-4110
Mailing Address - Country:US
Mailing Address - Phone:773-814-8663
Mailing Address - Fax:
Practice Address - Street 1:5400 WALNUT AVE UNIT 208
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-4110
Practice Address - Country:US
Practice Address - Phone:773-814-8663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-13
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.304446183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist