Provider Demographics
NPI:1578848321
Name:BETRRAND, ONEIL JOSEPH (RPH)
Entity Type:Individual
Prefix:
First Name:ONEIL
Middle Name:JOSEPH
Last Name:BETRRAND
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 1:10107 S CALUMET AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60628-2101
Mailing Address - Country:US
Mailing Address - Phone:773-931-9595
Mailing Address - Fax:
Practice Address - Street 1:10107 S CALUMET AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60628-2101
Practice Address - Country:US
Practice Address - Phone:773-931-9595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-12
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051-0361581835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy