Altijana Gallup, PHARMD
Individual provider Active NPI Pharmacist · Fox Lake, IL
NPI 1114200151 · NPPES record last updated Sep 26, 2011
Key facts
- NPI
- 1114200151
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 051.291168 (IL)
- Practice address
- 61 S Route 12
Fox Lake, IL 60020-1750 - Phone
- (847) 587-8222
- Fax
- (847) 587-0096
- NPI assigned
- Sep 26, 2011
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 051.291168 | IL | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 051.291168 | IL | Yes |
Addresses
Primary practice location
61 S Route 12
Fox Lake, IL 60020-1750
Mailing address
61 S Route 12
Fox Lake, IL 60020-1750
Phone (847) 587-8222
Other providers in Fox Lake, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 26, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.