Provider Demographics
NPI:1497036453
Name:BECTON-WOOTEN, LERIN CHANDA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:LERIN
Middle Name:CHANDA
Last Name:BECTON-WOOTEN
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 1:4631 S INDIANA AVE
Mailing Address - Street 2:UNIT #1N
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60653-3922
Mailing Address - Country:US
Mailing Address - Phone:708-769-5226
Mailing Address - Fax:
Practice Address - Street 1:1554 E 55TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60615-5550
Practice Address - Country:US
Practice Address - Phone:773-667-1177
Practice Address - Fax:773-947-0226
Is Sole Proprietor?:No
Enumeration Date:2011-09-06
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051289155183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist