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NPI Code Detail

MEDICARE: PEGGY SUSAN BICKHAM PHARMD

MEDICARE: PEGGY SUSAN BICKHAM PHARMD
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
1183500000XPharmacistIL

General Provider Information

NPI Number : 1861565889
Entity Type Code : Individual
Provider Name (Legal Business Name) : PEGGY SUSAN BICKHAM PHARMD
Provider Business Mailing Address
First Line : 4246 ARTHUR AVE
Second Line :
City : BROOKFIELD
State : IL
Zip : 60513-1914
Country : US
Telephone Number : 312-996-4270
Fax Number : 312-413-4146
Provider Business Practice Location Address
First Line : 1740 W TAYLOR ST
Second Line : ROOM C300 MAIL CODE 883
City : CHICAGO
State : IL
Zip : 60612-7232
Country : US
Telephone Number : 312-996-4270
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/16/2006
Last Update Date : 07/08/2007

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