Healthcare Provider Details

I. General information

NPI: 1821444332
Provider Name (Legal Business Name): KURT NEVEN PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2016
Last Update Date: 05/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

438 MADISON ST
OAK PARK IL
60302-4012
US

IV. Provider business mailing address

438 MADISON ST
OAK PARK IL
60302-4012
US

V. Phone/Fax

Practice location:
  • Phone: 708-358-1034
  • Fax:
Mailing address:
  • Phone: 708-358-1034
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051.294994
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: