Provider Demographics
NPI:1962006262
Name:BORN, JOHN ERICK (RPH)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:ERICK
Last Name:BORN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6200 W HIGGINS AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630-1823
Mailing Address - Country:US
Mailing Address - Phone:773-775-9316
Mailing Address - Fax:773-775-1174
Practice Address - Street 1:6200 W HIGGINS AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60630-1823
Practice Address - Country:US
Practice Address - Phone:773-775-9316
Practice Address - Fax:773-775-1174
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-26
Last Update Date:2020-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051285980183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist