Healthcare Provider Details

I. General information

NPI: 1467356543
Provider Name (Legal Business Name): JEFFREY GRAWE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2208 POPPLE CT
NAPERVILLE IL
60564-5390
US

IV. Provider business mailing address

2208 POPPLE CT
NAPERVILLE IL
60564-5390
US

V. Phone/Fax

Practice location:
  • Phone: 630-531-3848
  • Fax:
Mailing address:
  • Phone: 630-531-3848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number051038556
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: