Provider Demographics
NPI:1780959395
Name:SANTUCCI, GAIL (PHARM D)
Entity type:Individual
Prefix:
First Name:GAIL
Middle Name:
Last Name:SANTUCCI
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11700 S HOLMES AVE
Mailing Address - Street 2:
Mailing Address - City:PALOS PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60464-1047
Mailing Address - Country:US
Mailing Address - Phone:708-671-0236
Mailing Address - Fax:
Practice Address - Street 1:9915 W 159TH ST
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60467-4572
Practice Address - Country:US
Practice Address - Phone:708-645-5343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-14
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051035427183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist