Provider Demographics
NPI:1215384763
Name:HUPAC, THEODORE SR (BSPHARM)
Entity Type:Individual
Prefix:MR
First Name:THEODORE
Middle Name:
Last Name:HUPAC
Suffix:SR
Gender:M
Credentials:BSPHARM
Other - Prefix:MR
Other - First Name:THEODORE
Other - Middle Name:
Other - Last Name:HUPAC
Other - Suffix:SR
Other - Last Name Type:Professional Name
Other - Credentials:BSPHARM
Mailing Address - Street 1:9534 S ROBERTS RD
Mailing Address - Street 2:
Mailing Address - City:HICKORY HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60457-2239
Mailing Address - Country:US
Mailing Address - Phone:708-598-0564
Mailing Address - Fax:708-598-8684
Practice Address - Street 1:9534 S ROBERTS RD
Practice Address - Street 2:
Practice Address - City:HICKORY HILLS
Practice Address - State:IL
Practice Address - Zip Code:60457-2239
Practice Address - Country:US
Practice Address - Phone:708-598-0500
Practice Address - Fax:708-598-8684
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
IL051-034542183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist