Provider Demographics
NPI:1225019144
Name:GUERRA, JEROME TOOD (RPH)
Entity Type:Individual
Prefix:MR
First Name:JEROME
Middle Name:TOOD
Last Name:GUERRA
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 1:3308 N SPRINGFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-5112
Mailing Address - Country:US
Mailing Address - Phone:773-463-2807
Mailing Address - Fax:773-463-2831
Practice Address - Street 1:2807 N PULASKI RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60641-5419
Practice Address - Country:US
Practice Address - Phone:773-283-8150
Practice Address - Fax:773-283-3174
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist