Healthcare Provider Details

I. General information

NPI: 1386550143
Provider Name (Legal Business Name): ELIZABETH PAE
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3910 W OGDEN AVE
CHICAGO IL
60623-2470
US

IV. Provider business mailing address

3910 W OGDEN AVE
CHICAGO IL
60623-2470
US

V. Phone/Fax

Practice location:
  • Phone: 872-588-3250
  • Fax:
Mailing address:
  • Phone: 872-588-3250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051309301
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: