MEDICARE: DR. SUSAN E WOODEN PHARM.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	051.297051	IL

General Provider Information

NPI Number	:	1063840270
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUSAN E WOODEN PHARM.D.

Provider Business Mailing Address
First Line	:	678 N YORK ST
Second Line	:
City	:	ELMHURST
State	:	IL
Zip	:	60126-1605
Country	:	US
Telephone Number	:	630-782-0031
Fax Number	:	630-782-0048

Provider Business Practice Location Address
First Line	:	678 N YORK ST
Second Line	:
City	:	ELMHURST
State	:	IL
Zip	:	60126-1605
Country	:	US
Telephone Number	:	630-782-0031
Fax Number	:	630-782-0048

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/24/2013
Last Update Date	:	06/03/2026

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