Healthcare Provider Details

I. General information

NPI: 1093181182
Provider Name (Legal Business Name): BRIAN OVER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2015
Last Update Date: 08/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 SPALDING DR STE 101
NAPERVILLE IL
60540-6551
US

IV. Provider business mailing address

196 AMHERST CIR # IR
OSWEGO IL
60543-5200
US

V. Phone/Fax

Practice location:
  • Phone: 630-527-5204
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051040331
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: