Healthcare Provider Details

I. General information

NPI: 1871941559
Provider Name (Legal Business Name): OLEG BEBKO PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2016
Last Update Date: 02/20/2023
Certification Date: 02/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5545 S BRAINARD AVE
COUNTRYSIDE IL
60525-3542
US

IV. Provider business mailing address

5545 S BRAINARD AVE
COUNTRYSIDE IL
60525-3542
US

V. Phone/Fax

Practice location:
  • Phone: 708-354-5300
  • Fax:
Mailing address:
  • Phone: 708-354-5300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051288934
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: