Provider Demographics
NPI:1760680656
Name:BERNHEIM, FAYTHE SHERYL (RPH)
Entity Type:Individual
Prefix:
First Name:FAYTHE
Middle Name:SHERYL
Last Name:BERNHEIM
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 1:825 MOSELEY RD
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-4635
Mailing Address - Country:US
Mailing Address - Phone:847-433-7566
Mailing Address - Fax:
Practice Address - Street 1:1763 W HOWARD ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60626-1626
Practice Address - Country:US
Practice Address - Phone:773-274-1293
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051-034544183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist