Healthcare Provider Details

I. General information

NPI: 1740590942
Provider Name (Legal Business Name): ERIC JOHN PAULUS PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2010
Last Update Date: 10/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 RAND RD
DES PLAINES IL
60016-1005
US

IV. Provider business mailing address

77 RAND RD
DES PLAINES IL
60016-1005
US

V. Phone/Fax

Practice location:
  • Phone: 847-460-7414
  • Fax: 847-298-5939
Mailing address:
  • Phone: 847-460-7414
  • Fax: 847-298-5939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number21252
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number051.295144
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: