Provider Demographics
NPI:1477833184
Name:BRAIN, WILLIAM STUART (RPH)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:STUART
Last Name:BRAIN
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 1:160 N ROBERT T PALMER DR
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-3434
Mailing Address - Country:US
Mailing Address - Phone:630-782-1703
Mailing Address - Fax:630-782-5180
Practice Address - Street 1:160 N ROBERT T PALMER DR
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-3434
Practice Address - Country:US
Practice Address - Phone:630-782-1703
Practice Address - Fax:630-782-5180
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-25
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051034788183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL051-034788OtherILLINOIS STATE LICENSE