Healthcare Provider Details

I. General information

NPI: 1851672315
Provider Name (Legal Business Name): JENNIFER A. BEJAOUI RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2011
Last Update Date: 08/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 N SCHMALE RD
CAROL STREAM IL
60188-1867
US

IV. Provider business mailing address

319 LINCOLN AVE
DOWNERS GROVE IL
60515-3117
US

V. Phone/Fax

Practice location:
  • Phone: 630-933-9558
  • Fax:
Mailing address:
  • Phone: 630-971-0450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051.289050
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: