Provider Demographics
NPI:1205971413
Name:GILBERT, SUE L (PHARMD)
Entity type:Individual
Prefix:MS
First Name:SUE
Middle Name:L
Last Name:GILBERT
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 1:1854 WILLOW RD
Mailing Address - Street 2:
Mailing Address - City:HOMEWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60430-3367
Mailing Address - Country:US
Mailing Address - Phone:708-922-1870
Mailing Address - Fax:
Practice Address - Street 1:1218 SHEFFIELD AVE
Practice Address - Street 2:
Practice Address - City:DYER
Practice Address - State:IN
Practice Address - Zip Code:46311-1053
Practice Address - Country:US
Practice Address - Phone:219-865-4363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL26020705A1835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy