Provider Demographics
NPI:1043883838
Name:BEBO, EMLO (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:EMLO
Middle Name:
Last Name:BEBO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 S RANDALL RD
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-4109
Mailing Address - Country:US
Mailing Address - Phone:847-468-9696
Mailing Address - Fax:847-468-8077
Practice Address - Street 1:1100 S RANDALL RD
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-4109
Practice Address - Country:US
Practice Address - Phone:847-468-9696
Practice Address - Fax:847-468-5077
Is Sole Proprietor?:No
Enumeration Date:2021-07-20
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051304032183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist