Provider Demographics
NPI:1740498963
Name:BEJNAROWICZ, LARRY C (RPH)
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:C
Last Name:BEJNAROWICZ
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 1:7004 ROBERTS DR
Mailing Address - Street 2:
Mailing Address - City:WOODRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60517-1903
Mailing Address - Country:US
Mailing Address - Phone:630-964-5186
Mailing Address - Fax:
Practice Address - Street 1:2353 63RD ST
Practice Address - Street 2:
Practice Address - City:WOODRIDGE
Practice Address - State:IL
Practice Address - Zip Code:60517-1300
Practice Address - Country:US
Practice Address - Phone:630-493-9084
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL51-027339183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist