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General NPI Number Information
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NPI Number | 1841719705
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Entity Type | Individual
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Provider Name | ANEENA SUSAN PHILIP
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Gender | Female
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Dates
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Enumeration Date | 09/12/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 547 W LIBERTY STREET
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City | WAUCONDA
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State | IL
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Zip | 60084
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Country | US
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Telephone | 847-526-1239
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Fax |
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Provider Business Mailing Address
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Address Line | 547 W LIBERTY ST
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City | WAUCONDA
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State | IL
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Zip | 60084-2470
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Country | US
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Telephone | 847-526-1239
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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 | 051291647
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License Number State | IL
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