Provider Demographics
NPI:1801496971
Name:O'MALLEY, JULIA (PHARMD)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:O'MALLEY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6255 W NEWPORT AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60634-4144
Mailing Address - Country:US
Mailing Address - Phone:773-655-2958
Mailing Address - Fax:
Practice Address - Street 1:1455 E LAKE COOK RD
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:IL
Practice Address - Zip Code:60090-2241
Practice Address - Country:US
Practice Address - Phone:847-537-5527
Practice Address - Fax:847-537-5929
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-28
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051293685183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist