MEDICARE: SUZANNE BURDICK

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	051040986	IL

General Provider Information

NPI Number	:	1528495348
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUZANNE BURDICK

Provider Business Mailing Address
First Line	:	578 SYCAMORE CIR
Second Line	:
City	:	WAUCONDA
State	:	IL
Zip	:	60084-2379
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 E ROLLINS RD
Second Line	:
City	:	ROUND LAKE BEACH
State	:	IL
Zip	:	60073-1334
Country	:	US
Telephone Number	:	847-740-3685
Fax Number	:

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

Provider Enumeration Date	:	10/11/2013
Last Update Date	:	10/11/2013

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