Provider Demographics
NPI:1770748576
Name:BEWLEY, MAY LO (BS PHARMACY)
Entity type:Individual
Prefix:
First Name:MAY
Middle Name:LO
Last Name:BEWLEY
Suffix:
Gender:F
Credentials:BS PHARMACY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:FIFTH AVE AND ROOSEVELT ROAD, BLDG 37
Mailing Address - Street 2:CMOP
Mailing Address - City:HINES
Mailing Address - State:IL
Mailing Address - Zip Code:60141-5221
Mailing Address - Country:US
Mailing Address - Phone:708-786-7820
Mailing Address - Fax:
Practice Address - Street 1:FIFTH AVE AND ROOSEVELT, BLDG 37
Practice Address - Street 2:CMOP
Practice Address - City:HINES
Practice Address - State:IL
Practice Address - Zip Code:60141-5221
Practice Address - Country:US
Practice Address - Phone:708-786-7820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-22
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051-029899183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist