Provider Demographics
NPI:1083217285
Name:BLUM, STEVEN JEFFREY (RPH)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:JEFFREY
Last Name:BLUM
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3530 MELODY ST
Mailing Address - Street 2:
Mailing Address - City:MUNDELEIN
Mailing Address - State:IL
Mailing Address - Zip Code:60060-6011
Mailing Address - Country:US
Mailing Address - Phone:847-840-2234
Mailing Address - Fax:
Practice Address - Street 1:1101 W MAPLE AVE
Practice Address - Street 2:
Practice Address - City:MUNDELEIN
Practice Address - State:IL
Practice Address - Zip Code:60060-1437
Practice Address - Country:US
Practice Address - Phone:847-949-2090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-19
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.032149183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist