Provider Demographics
NPI:1821190661
Name:BAE, KATIE S (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KATIE
Middle Name:S
Last Name:BAE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:KYONG
Other - Middle Name:S
Other - Last Name:BAE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:6245 PINE TREE DR
Mailing Address - Street 2:
Mailing Address - City:LONG GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60047-5176
Mailing Address - Country:US
Mailing Address - Phone:847-951-5939
Mailing Address - Fax:
Practice Address - Street 1:3001 GREEN BAY RD
Practice Address - Street 2:
Practice Address - City:NORTH CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60064-3048
Practice Address - Country:US
Practice Address - Phone:224-610-5546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy