Active NPI
Nicole Wallace
- Pharmacy Technician
- Chicago, IL
National Provider Identifier
1285507301
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacy Technician
- License
- 049290929
- Practice address
- 675 N Saint Clair St Ste 19-100
Chicago, IL 60611-5969 - Phone
- (312) 926-2749
- Fax
- (312) 694-6830
- NPI assigned
- Sep 25, 2025
- 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 |
|---|---|---|---|---|
| Pharmacy Technician | 183700000X | 049290929 | IL | Primary |
Addresses
Primary practice location
675 N Saint Clair St Ste 19-100
Chicago, IL 60611-5969
Mailing address
675 N Saint Clair St Ste 19-100
Chicago, IL 60611-5969
Phone (312) 926-2749
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 049290929 | IL | MD | Pharmacy Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1758758400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1758758400000",
"number": "1285507301",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "675 N SAINT CLAIR ST STE 19-100",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606115969",
"telephone_number": "312-926-2749",
"fax_number": "312-694-6830"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "675 N SAINT CLAIR ST STE 19-100",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606115969",
"telephone_number": "312-926-2749",
"fax_number": "312-694-6830"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLACE",
"first_name": "NICOLE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2025-09-25",
"last_updated": "2025-09-25",
"certification_date": "2025-09-25",
"status": "A"
},
"taxonomies": [
{
"code": "183700000X",
"taxonomy_group": "",
"desc": "Pharmacy Technician",
"state": "IL",
"license": "049290929",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.