Provider Demographics
NPI:1558481598
Name:ANNES, RICK JOHN
Entity Type:Individual
Prefix:
First Name:RICK
Middle Name:JOHN
Last Name:ANNES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1816 BROPHY AVE
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-5202
Mailing Address - Country:US
Mailing Address - Phone:847-692-4235
Mailing Address - Fax:
Practice Address - Street 1:1816 BROPHY AVE
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-5202
Practice Address - Country:US
Practice Address - Phone:847-692-4235
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist