NPIMap

Organization Active NPI

Board of Trustees of the University of Illinois

Doing business as University of Illinois Mile Square Neighborhood Clinic Pharmacy

  • Clinic Pharmacy
  • Chicago, IL
National Provider Identifier
1790826352
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic PharmacyTaxonomy code 3336C0002X
License
054.017118 Issued in IL
Legal business name
BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS
Doing business as
University of Illinois Mile Square Neighborhood Clinic Pharmacy
Practice address
1220 S Wood St
Room 1045 MC 884
Chicago, IL 60608-1202
Phone
(312) 413-1767
Fax
(312) 355-1916
NPI assigned
Feb 8, 2007
Last updated
Mar 7, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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

Authorized official

Name
Ms. Kristine D Vankuiken, CPHT
Title
Pharmacy Technician Specialist
Phone
(312) 355-2035

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic Pharmacy 3336C0002X 054.017118 IL Primary

Addresses

Primary practice location

1220 S Wood St
Room 1045 MC 884
Chicago, IL 60608-1202

Mailing address

840 S Wood St
Room 345H MC 884
Chicago, IL 60612-4325
Phone (312) 355-2035

Other identifiers 4

IdentifierTypeStateIssuer
032-005960OtherILSTATE CONTROLLED SUBSTANC
1418006OtherIDNCPDP NUMBER
093-010041OtherILSTATE LICENSE NUMBER
054-017118OtherILSTATE PHARMACY LICENSE

Other names 1

  • University of Illinois Mile Square Neighborhood Clinic Pharmacy Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Uic Dept of Pathology122 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Locations

1220 S Wood St
Rm 1045
Chicago, IL 60608
Phone (312) 413-1767

NPI Registry JSON

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

{
    "created_epoch": "1170892800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678147200000",
    "number": "1790826352",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "840 S WOOD ST",
            "address_2": "ROOM 345H MC 884",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606124325",
            "telephone_number": "312-355-2035",
            "fax_number": "312-355-1916"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1220 S WOOD ST",
            "address_2": "ROOM 1045 MC 884",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606081202",
            "telephone_number": "312-413-1767",
            "fax_number": "312-355-1916"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-08",
        "last_updated": "2023-03-07",
        "status": "A",
        "authorized_official_last_name": "VANKUIKEN",
        "authorized_official_first_name": "KRISTINE",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "PHARMACY TECHNICIAN SPECIALIST",
        "authorized_official_telephone_number": "312-355-2035",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "CPHT"
    },
    "taxonomies": [
        {
            "code": "3336C0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Clinic Pharmacy",
            "state": "IL",
            "license": "054.017118",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE CONTROLLED SUBSTANC",
            "identifier": "032-005960",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP NUMBER",
            "identifier": "1418006",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE NUMBER",
            "identifier": "093-010041",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE PHARMACY LICENSE",
            "identifier": "054-017118",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "University of Illinois Mile Square Neighborhood Clinic Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Mar 7, 2023; 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.