Healthcare Provider Details

I. General information

NPI: 1457473936
Provider Name (Legal Business Name): SUSAN MARIE BERG B.S.,R.PH.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUSAN MARIE STEFFENS B.S.,R.PH.

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 N CHILDRENS PLZ CHILDREN'S MEMORIAL HOSPITAL
CHICAGO IL
60614-3363
US

IV. Provider business mailing address

1133 W ALBION AVE
CHICAGO IL
60626-4613
US

V. Phone/Fax

Practice location:
  • Phone: 773-880-4566
  • Fax: 773-880-4295
Mailing address:
  • Phone: 773-743-0435
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: