Provider Demographics
NPI:1902226020
Name:STURT, JEFFREY (RPHBS)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:STURT
Suffix:
Gender:M
Credentials:RPHBS
Other - Prefix:
Other - First Name:JEFFREY
Other - Middle Name:
Other - Last Name:STURT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPHBS
Mailing Address - Street 1:524 KNOX AVE
Mailing Address - Street 2:
Mailing Address - City:WILMETTE
Mailing Address - State:IL
Mailing Address - Zip Code:60091-2170
Mailing Address - Country:US
Mailing Address - Phone:847-502-0056
Mailing Address - Fax:847-256-1368
Practice Address - Street 1:524 KNOX AVE
Practice Address - Street 2:
Practice Address - City:WILMETTE
Practice Address - State:IL
Practice Address - Zip Code:60091-2170
Practice Address - Country:US
Practice Address - Phone:847-502-0056
Practice Address - Fax:847-256-1368
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-16
Last Update Date:2014-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL51.028866183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist