Provider Demographics
NPI:1588391452
Name:WALDHOFF, JILL (PHARMD)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:WALDHOFF
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 W UNIVERSITY AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61820-4039
Mailing Address - Country:US
Mailing Address - Phone:217-366-1278
Mailing Address - Fax:
Practice Address - Street 1:101 W UNIVERSITY AVE STE 102
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61820-4039
Practice Address - Country:US
Practice Address - Phone:217-366-1278
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-02
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051292790183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist