Provider Demographics
NPI:1114294360
Name:BURGE, SUSIE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SUSIE
Middle Name:
Last Name:BURGE
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 1:201 W MADISON ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60606-3317
Mailing Address - Country:US
Mailing Address - Phone:312-214-4385
Mailing Address - Fax:312-214-4479
Practice Address - Street 1:201 W MADISON ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60606-3317
Practice Address - Country:US
Practice Address - Phone:312-214-4385
Practice Address - Fax:312-214-4479
Is Sole Proprietor?:No
Enumeration Date:2011-11-16
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051287947183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist