Provider Demographics
NPI:1831441500
Name:MIELCAREK, KRISTY N (PHARMD)
Entity type:Individual
Prefix:DR
First Name:KRISTY
Middle Name:N
Last Name:MIELCAREK
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 1:438 MADISON ST
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-4012
Mailing Address - Country:US
Mailing Address - Phone:708-358-0935
Mailing Address - Fax:708-358-1173
Practice Address - Street 1:438 MADISON ST
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-4012
Practice Address - Country:US
Practice Address - Phone:708-358-0935
Practice Address - Fax:708-358-1173
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-05
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.291810183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist