Healthcare Provider Details

I. General information

NPI: 1205971413
Provider Name (Legal Business Name): SUE L GILBERT PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1218 SHEFFIELD AVE
DYER IN
46311-1053
US

IV. Provider business mailing address

1854 WILLOW RD
HOMEWOOD IL
60430-3367
US

V. Phone/Fax

Practice location:
  • Phone: 219-865-4363
  • Fax:
Mailing address:
  • Phone: 708-922-1870
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number26020705A
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: