Provider Demographics
NPI:1487855979
Name:BLOOM, DEBBIE LYNN (RPH)
Entity Type:Individual
Prefix:MRS
First Name:DEBBIE
Middle Name:LYNN
Last Name:BLOOM
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 1:3140 CENTENNIAL CT
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-1016
Mailing Address - Country:US
Mailing Address - Phone:847-433-1507
Mailing Address - Fax:847-433-6776
Practice Address - Street 1:1600 DEERFIELD RD
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-3708
Practice Address - Country:US
Practice Address - Phone:847-579-0884
Practice Address - Fax:847-579-0895
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist