Healthcare Provider Details

I. General information

NPI: 1649592593
Provider Name (Legal Business Name): JOHN C GEBHARDT RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2010
Last Update Date: 02/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11000 S CICERO AVE
OAK LAWN IL
60453-5504
US

IV. Provider business mailing address

11000 S CICERO AVE
OAK LAWN IL
60453-5504
US

V. Phone/Fax

Practice location:
  • Phone: 708-424-6671
  • Fax: 708-424-7511
Mailing address:
  • Phone: 708-424-6671
  • Fax: 708-424-7511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051-027117
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: