Provider Demographics
NPI:1912654062
Name:ROBINSON, ALEXIS
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:
Last Name:ROBINSON
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 1:3000 S HALSTED ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60608-5805
Mailing Address - Country:US
Mailing Address - Phone:312-225-0537
Mailing Address - Fax:
Practice Address - Street 1:3000 S HALSTED ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-5805
Practice Address - Country:US
Practice Address - Phone:312-225-0537
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-08
Last Update Date:2024-01-25
Deactivation Date:2024-01-17
Deactivation Code:
Reactivation Date:2024-01-24
Provider Licenses
StateLicense IDTaxonomies
IL051.306091183500000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes183500000XPharmacy Service ProvidersPharmacist