Provider Demographics
NPI:1083982151
Name:TU, JIM (PHARMD)
Entity type:Individual
Prefix:
First Name:JIM
Middle Name:
Last Name:TU
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 W CHICAGO AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60654-5105
Mailing Address - Country:US
Mailing Address - Phone:312-280-1599
Mailing Address - Fax:312-280-2808
Practice Address - Street 1:315 W CHICAGO AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60654-5105
Practice Address - Country:US
Practice Address - Phone:312-280-1599
Practice Address - Fax:312-280-2808
Is Sole Proprietor?:No
Enumeration Date:2011-12-05
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051286242183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist