Kevin Wabomnor, PHARMD

Primary specialty

PharmacistTaxonomy code 183500000X

License

051303755 Issued in IL

Practice address

2656 N Elston Ave
Chicago, IL 60647-2019

Phone

(773) 252-2210

NPI assigned

Mar 9, 2021

Last updated

Mar 9, 2021By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Pharmacy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1615248000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615248000000",
    "number": "1609461862",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2656 N ELSTON AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606472019",
            "telephone_number": "773-252-2210"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2656 N ELSTON AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606472019",
            "telephone_number": "773-252-2210"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WABOMNOR",
        "first_name": "KEVIN",
        "name_prefix": "Dr.",
        "credential": "PHARMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-03-09",
        "last_updated": "2021-03-09",
        "certification_date": "2021-03-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "IL",
            "license": "051303755",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• W.J.Slodowy M.D.Inc.
• Samira E Waanders-Panwala, PT
• Angela Jae Waanders, M.D., MPH
• Joseph Wabomnor, PA-C
• Joseph Chuka Wabomnor, DC
• Camille Wachholz
• Laura Wachs, OTR/L
• Kelley Nash Wachsberg
• Carrie C Wachter, LPC
• Jill Wachter

• Pharmacist in Chicago, IL
• Providers in Chicago, IL by specialty
• Pharmacist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.