Healthcare Provider Details

I. General information

NPI: 1255937272
Provider Name (Legal Business Name): BRIAN HRAD PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2020
Last Update Date: 12/06/2020
Certification Date: 12/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 S MAPLE AVE STE 1600
OAK PARK IL
60304-1096
US

IV. Provider business mailing address

610 S MAPLE AVE STE 1600
OAK PARK IL
60304-1096
US

V. Phone/Fax

Practice location:
  • Phone: 708-660-6822
  • Fax: 708-660-6821
Mailing address:
  • Phone: 708-660-6822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051292052
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: