Provider Demographics
NPI:1639210461
Name:TRIMUEL, FRED T (RPH)
Entity type:Individual
Prefix:MR
First Name:FRED
Middle Name:T
Last Name:TRIMUEL
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 1:559 W. 103RD STREET
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60628-2403
Mailing Address - Country:US
Mailing Address - Phone:773-238-8680
Mailing Address - Fax:773-238-8634
Practice Address - Street 1:559 W 103RD ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60628-2403
Practice Address - Country:US
Practice Address - Phone:773-238-8680
Practice Address - Fax:773-238-8634
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1414387OtherNDP