Healthcare Provider Details

I. General information

NPI: 1891905741
Provider Name (Legal Business Name): BRETT PINE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2075 N LINCOLN AVE
CHICAGO IL
60614-4536
US

IV. Provider business mailing address

1227 N NOBLE ST APT 2N
CHICAGO IL
60622-3378
US

V. Phone/Fax

Practice location:
  • Phone: 773-549-7387
  • Fax:
Mailing address:
  • Phone: 847-858-6411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: