Provider Demographics
NPI:1891811717
Name:BERMAN, DENNIS SIMSON (R PH)
Entity Type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:SIMSON
Last Name:BERMAN
Suffix:
Gender:M
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 VILLAGE GREEN
Mailing Address - Street 2:302
Mailing Address - City:LINCOLNSHIRE
Mailing Address - State:IL
Mailing Address - Zip Code:60069
Mailing Address - Country:US
Mailing Address - Phone:847-955-9373
Mailing Address - Fax:
Practice Address - Street 1:1822 WILLOW RD.
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:IL
Practice Address - Zip Code:60093
Practice Address - Country:US
Practice Address - Phone:847-446-4102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist