Provider Demographics
NPI:1285234633
Name:CHAVEZ, RAMON JR (PHARMD)
Entity type:Individual
Prefix:DR
First Name:RAMON
Middle Name:
Last Name:CHAVEZ
Suffix:JR
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 1:2140 N LINCOLN PARK W APT 1003
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-4668
Mailing Address - Country:US
Mailing Address - Phone:402-595-8779
Mailing Address - Fax:
Practice Address - Street 1:200 S BOLINGBROOK DR
Practice Address - Street 2:
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-2932
Practice Address - Country:US
Practice Address - Phone:630-739-4883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020032382183500000X
IL051.301433183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist