Provider Demographics
NPI:1093162539
Name:BRISKU, BLANDINA
Entity Type:Individual
Prefix:
First Name:BLANDINA
Middle Name:
Last Name:BRISKU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2491 HOWARD ST
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-3638
Mailing Address - Country:US
Mailing Address - Phone:847-328-9951
Mailing Address - Fax:847-328-9849
Practice Address - Street 1:2491 HOWARD ST
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202-3638
Practice Address - Country:US
Practice Address - Phone:847-328-9951
Practice Address - Fax:847-328-9849
Is Sole Proprietor?:No
Enumeration Date:2016-05-14
Last Update Date:2016-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051289506183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist