Active NPI
Kori Ann Kallenborn, PHARMD
- Pharmacist
- Hines, IL
National Provider Identifier
1073806279
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 051.294101
- Practice address
- 5000 S 5TH Ave
Hines, IL 60141-3030 - Phone
- (708) 202-8387
- NPI assigned
- May 20, 2011
- Last updated
- May 20, 2011
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 051.294101 | IL | Primary |
Addresses
Primary practice location
5000 S 5TH Ave
Hines, IL 60141-3030
Mailing address
12231 S Nagle Ave
Palos Heights, IL 60463-1721
Phone (708) 296-5655
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 051.294101 | IL | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1305849600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1305849600000",
"number": "1073806279",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12231 S NAGLE AVE",
"city": "PALOS HEIGHTS",
"state": "IL",
"postal_code": "604631721",
"telephone_number": "708-296-5655"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5000 S 5TH AVE",
"city": "HINES",
"state": "IL",
"postal_code": "601413030",
"telephone_number": "708-202-8387"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KALLENBORN",
"first_name": "KORI",
"middle_name": "ANN",
"name_prefix": "Dr.",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-05-20",
"last_updated": "2011-05-20",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "IL",
"license": "051.294101",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hines, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.