Healthcare Provider Details

I. General information

NPI: 1699701573
Provider Name (Legal Business Name): JULIE M STEIN-GOCKEN PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

FIFTH AVENUE AND ROOSEVELT ROAD PHARMACY SERVICE (119)
HINES IL
60141
US

IV. Provider business mailing address

1803 RIVER RIDGE CIR
NAPERVILLE IL
60565-2400
US

V. Phone/Fax

Practice location:
  • Phone: 708-202-8387
  • Fax: 708-202-2088
Mailing address:
  • Phone: 630-637-9211
  • Fax: 708-202-2088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: