Provider Demographics
NPI:1437430121
Name:SORISHO, SUSAN B (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:B
Last Name:SORISHO
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 1:7318 N EAST PRAIRIE RD
Mailing Address - Street 2:
Mailing Address - City:LINCOLNWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60712-1010
Mailing Address - Country:US
Mailing Address - Phone:847-679-1925
Mailing Address - Fax:773-267-5071
Practice Address - Street 1:7318 N EAST PRAIRIE RD
Practice Address - Street 2:
Practice Address - City:LINCOLNWOOD
Practice Address - State:IL
Practice Address - Zip Code:60712
Practice Address - Country:US
Practice Address - Phone:847-679-1925
Practice Address - Fax:773-267-5071
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-08
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051-039989183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist