Provider Demographics
NPI:1851648893
Name:WETHERHOLT, EMILY LOUISE SIERACKI (PHARMD)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:LOUISE SIERACKI
Last Name:WETHERHOLT
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 1:7350 BARRINGTON RD
Mailing Address - Street 2:
Mailing Address - City:HANOVER PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60133-3301
Mailing Address - Country:US
Mailing Address - Phone:630-289-4143
Mailing Address - Fax:630-289-5218
Practice Address - Street 1:7350 BARRINGTON RD
Practice Address - Street 2:
Practice Address - City:HANOVER PARK
Practice Address - State:IL
Practice Address - Zip Code:60133-3301
Practice Address - Country:US
Practice Address - Phone:630-289-4143
Practice Address - Fax:630-289-5218
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-09
Last Update Date:2021-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.295856183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist