KELLY DECANIO (NPI# 1669974309) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1669974309 |
| Entity Type | Individual |
| Full Name | KELLY DECANIO |
| Practice Address |
1435 Lake Cook Rd Deerfield IL 60015-5213 |
| Mailing Address |
5 Brentwood Dr Hawthorn Woods IL 60047-7402 |
| Practice Telephone | 8476879974 |
| Enumeration Date | 2018-03-07 |
| Last Update Date | 2018-03-07 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
051298728 | IL | Suppliers |
| Street Address |
1435 LAKE COOK RD |
| City | DEERFIELD |
| State | IL |
| Zip Code | 60015-5213 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467073569 | Steven A Ditgen | Physical Therapist | 43 N. Waukegan Road, Deerfield, IL 60015 | 2020-04-29 |
| 1760017255 | Amanda Barkley | Pharmacist | 200 Wilmont Rd, Deerfield, IL 60015 | 2020-03-05 |
| 1467001487 | Nora Fahmi | Pharmacist | Walgreen Co., 200 Wilmot Road, Deerfield, IL 60015 | 2019-09-11 |
| 1477105187 | Anthony Greis | Obstetrics & Gynecology | 540 Lake Cook Road, Suite 300, Deerfield, IL 60015 | 2019-07-12 |
| 1528628484 | Cynthia Lynne Mckinzie | Psychologist | The Neuroscience Center, 440 Lake Cook Road, Deerfield, IL 60015 | 2019-06-13 |
| 1073084497 | Mary Jeane Jeane Velez | Nurse Practitioner | Brentwood Rehabilitation Center, 3705 Deerfield Rd., Deerfield, IL 60015 | 2018-12-11 |
| 1891264644 | Smile On of North Shore, PC | Dentist | 707 Lake Cook Rd., Suite 121, Deerfield, IL 60015 | 2018-11-21 |
| 1497236376 | Linda Li | Counselor | 15 Parkway North Blvd, Deerfield, IL 60015 | 2018-08-28 |
| 1174009831 | Rachael Michelle Lynn | Physician Assistant | 1302 Hazel Ave, Deerfield, IL 60015 | 2018-07-16 |
| 1730675182 | Alexandra Lee Joseph | Social Worker | 420 Lake Cook Road, Suite 113, Deerfield, IL 60015 | 2018-07-09 |
| Find all providers in zip 60015 | ||||
| Taxonomy Code | 3336C0003X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| Specialization | Community/Retail Pharmacy |
| A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes. |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376927699 | Walgreen Co | Pharmacy | 200 Wilmot Rd, Ms 2140, Deerfield, IL 60015-4620 | 2015-07-16 |
| 1356610570 | Md Group, LLC | Pharmacy | 10 Liberty St, Suite 106, Deerfield, WI 53531-9458 | 2011-12-16 |
| 1114200938 | Walgreens | Pharmacy | 780 Waukegan Rd, Deerfield, IL 60015-4305 | 2011-09-28 |
| 1669755484 | Bond Drug Company of Illinois, L.L.C. | Pharmacy | 780 Waukegan Rd, Deerfield, IL 60015-4305 | 2011-09-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215538582 | Wilmington Pharmacy LLC | Pharmacy | 600 W Baltimore St, Wilmington, IL 60481-1281 | 2020-11-03 |
| 1952909632 | Cordant Pharmacy Illinois, LLC | Pharmacy | 8623 W Bryn Mawr Ave Ste 504, Chicago, IL 60631-3525 | 2020-10-14 |
| 1386242352 | Letitride, Inc. | Pharmacy | 501 W Oak Street, Fairbury, IL 61739 | 2020-10-13 |
| 1699389890 | J2sb LLC | Pharmacy | 398 W Army Trail Rd Ste 120, Bloomingdale, IL 60108-2398 | 2020-09-04 |
| 1891308045 | Apotheco Pharmacy Lincoln Park LLC | Pharmacy | 2140 N Halsted St, Chicago, IL 60614-4385 | 2020-08-27 |
| 1982217345 | Costco Wholesale Corporation | Pharmacy | 2002 N. Neil St., Champaign, IL 61820 | 2020-08-26 |
| 1710599485 | Costco Wholesale Corporation | Pharmacy | 16261 S Boulevard Pl, Plainfield, IL 60586-4400 | 2020-08-23 |
| 1982212635 | Grand Pharmacy LLC | Pharmacy | 229 W Grand Ave Ste F, Bensenville, IL 60106-3365 | 2020-07-20 |
| 1871110254 | Illini Clinic Pharmacy Inc | Pharmacy | 103 N Prospect St, Cambridge, IL 61238-1148 | 2020-07-01 |
| 1831716745 | The Project of The Quad Cities | Pharmacy | 1701 River Dr Ste 106, Moline, IL 61265-1384 | 2020-06-26 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.