MEDICARE: MRS. ELIZABETH SUH PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	051289031	IL

General Provider Information

NPI Number	:	1508460320
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ELIZABETH SUH PHARMD

Provider Business Mailing Address
First Line	:	2255 CHESTNUT AVE
Second Line	:
City	:	GLENVIEW
State	:	IL
Zip	:	60026-1676
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3101 N CLARK ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-4413
Country	:	US
Telephone Number	:	847-293-3068
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/23/2020
Last Update Date	:	11/23/2020

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