Provider Demographics
NPI:1457653578
Name:FUGIEL, BEVERLY ANN (RPH)
Entity Type:Individual
Prefix:MS
First Name:BEVERLY
Middle Name:ANN
Last Name:FUGIEL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7342 N OLCOTT AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631-4317
Mailing Address - Country:US
Mailing Address - Phone:773-763-0471
Mailing Address - Fax:
Practice Address - Street 1:2520 N NARRAGANSETT AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60639-1041
Practice Address - Country:US
Practice Address - Phone:773-637-1819
Practice Address - Fax:773-637-1875
Is Sole Proprietor?:No
Enumeration Date:2010-11-22
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051-035592183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist