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General NPI Number Information
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NPI Number | 1295850600
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Entity Type | Individual
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Provider Name | JOAN SERGO R.PH.
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Gender | Female
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Dates
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Enumeration Date | 03/21/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 259 LAKE ST
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City | OAK PARK
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State | IL
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Zip | 60302-2636
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Country | US
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Telephone | 708-525-1736
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Fax | 708-383-9172
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Provider Business Mailing Address
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Address Line | 8501 WASHINGTON AVE
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City | BROOKFIELD
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State | IL
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Zip | 60513-1705
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Country | US
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Telephone | 708-387-7124
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number |
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License Number State | IL
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