Provider Demographics
NPI:1780266007
Name:QODOSH NATURALS HEALTH AND WELLNESS
Entity type:Organization
Organization Name:QODOSH NATURALS HEALTH AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FMNP
Authorized Official - Prefix:MS
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SALLEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-214-7700
Mailing Address - Street 1:77 W WASHINGTON ST STE 1614
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602-3555
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:77 W WASHINGTON ST STE 1614
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-3555
Practice Address - Country:US
Practice Address - Phone:779-301-4523
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:QODOSH NATURALS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-04-26
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Multi-Specialty