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General NPI Number Information
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NPI Number | 1548880966
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Entity Type | Individual
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Provider Name | STACY TRESA JOSEPH PHARMD
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Gender | Female
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Dates
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Enumeration Date | 04/26/2020
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Last Update Date | 04/28/2020
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Provider Practice Location Address
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Address Line | 189 W NORTHWEST HWY
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City | BARRINGTON
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State | IL
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Zip | 60010-3107
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Country | US
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Telephone | 847-381-0689
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Fax |
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Provider Business Mailing Address
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Address Line | 7105 FOSTER ST
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City | MORTON GROVE
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State | IL
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Zip | 60053-1215
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Country | US
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Telephone | 847-942-2199
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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 | 051302026
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License Number State | IL
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