Provider Demographics
NPI:1780978874
Name:N.G., PETER (PHARMD)
Entity type:Individual
Prefix:MR
First Name:PETER
Middle Name:
Last Name:N.G.
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6601 GRAND AVE
Mailing Address - Street 2:TARGET T-0865
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-4591
Mailing Address - Country:US
Mailing Address - Phone:847-244-4299
Mailing Address - Fax:
Practice Address - Street 1:6601 GRAND AVE
Practice Address - Street 2:TARGET T-0865
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-4591
Practice Address - Country:US
Practice Address - Phone:847-244-4299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-06
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051-286088183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist