Healthcare Provider Details

I. General information

NPI: 1427405943
Provider Name (Legal Business Name): ANMARIE SEFCIK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2016
Last Update Date: 05/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2038 PRAIRIE ST
ST CHARLES IL
60174-3578
US

IV. Provider business mailing address

2038 PRAIRIE ST
ST CHARLES IL
60174-3578
US

V. Phone/Fax

Practice location:
  • Phone: 630-377-1655
  • Fax: 630-377-2622
Mailing address:
  • Phone: 630-377-1655
  • Fax: 630-377-2622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number054.006975
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: