Healthcare Provider Details

I. General information

NPI: 1750409140
Provider Name (Legal Business Name): MICHAEL P PEREJDA RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21001 S LAGRANGE RD
FRANKFORT IL
60423-2006
US

IV. Provider business mailing address

8419 RADCLIFFE RD
TINLEY PARK IL
60487-2155
US

V. Phone/Fax

Practice location:
  • Phone: 815-464-3562
  • Fax: 815-464-4820
Mailing address:
  • Phone: 708-217-7839
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051289587
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number051289587
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: