Healthcare Provider Details

I. General information

NPI: 1508979675
Provider Name (Legal Business Name): EDITH A NUTESCU PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 W TAYLOR ST SUITE 1C
CHICAGO IL
60612-4319
US

IV. Provider business mailing address

833 S WOOD ST ROOM 164; MC 886
CHICAGO IL
60612-7229
US

V. Phone/Fax

Practice location:
  • Phone: 312-355-0117
  • Fax: 312-355-3133
Mailing address:
  • Phone: 312-996-0880
  • Fax: 312-413-4805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: