Provider Demographics
NPI:1396172813
Name:CENCULA, NILUBOL (RPH)
Entity type:Individual
Prefix:MS
First Name:NILUBOL
Middle Name:
Last Name:CENCULA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:NILUBOL
Other - Middle Name:
Other - Last Name:YUTIWONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4201 W MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60050-8409
Mailing Address - Country:US
Mailing Address - Phone:815-344-5000
Mailing Address - Fax:815-759-8090
Practice Address - Street 1:4201 W MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050-8409
Practice Address - Country:US
Practice Address - Phone:815-344-5000
Practice Address - Fax:815-759-8090
Is Sole Proprietor?:No
Enumeration Date:2013-09-29
Last Update Date:2013-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051296551183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist