Provider Demographics
NPI:1851681407
Name:GUERRERO GRAY, SUSAN A (SUSAN GUERRERO GRAY)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:A
Last Name:GUERRERO GRAY
Suffix:
Gender:F
Credentials:SUSAN GUERRERO GRAY
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:
Other - Last Name:GRAY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:1926 W 35TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60609-1204
Mailing Address - Country:US
Mailing Address - Phone:773-254-5523
Mailing Address - Fax:773-254-9537
Practice Address - Street 1:1926 W 35TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60609-1204
Practice Address - Country:US
Practice Address - Phone:773-254-5523
Practice Address - Fax:773-254-9537
Is Sole Proprietor?:No
Enumeration Date:2011-04-17
Last Update Date:2011-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.038947183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL051.038947OtherDEPARTMENT OF FINANCIAL AND PROFESSIONAL REGULATION