Provider Demographics
NPI:1609270008
Name:KURILLA, SUSAN (PHARMD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:KURILLA
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 1:2021 GOLF COURSE VIEW DR
Mailing Address - Street 2:
Mailing Address - City:EDWARDSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62025-3735
Mailing Address - Country:US
Mailing Address - Phone:618-960-6793
Mailing Address - Fax:
Practice Address - Street 1:50 NORTHGATE INDUSTRIAL DR
Practice Address - Street 2:RM 717
Practice Address - City:GRANITE CITY
Practice Address - State:IL
Practice Address - Zip Code:62040-6805
Practice Address - Country:US
Practice Address - Phone:618-709-4030
Practice Address - Fax:618-709-4016
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-14
Last Update Date:2014-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.290369183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist