Sue Jackson
Individual provider Active NPI Pharmacist · Huntley, IL
NPI 1467079475 · NPPES record last updated Jun 25, 2020
Key facts
- NPI
- 1467079475
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 051303064 (IL)
- Practice address
- 13200 Village Green Dr
Huntley, IL 60142-8039 - Phone
- (847) 961-5625
- NPI assigned
- Jun 25, 2020
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 051303064 | IL | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| American Drug Stores LLC | Past |
Accepting new patients | |
| American Drug Stores LLC | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 051303064 | IL | Yes |
Addresses
Primary practice location
13200 Village Green Dr
Huntley, IL 60142-8039
Mailing address
13200 Village Green Dr
Huntley, IL 60142-8039
Other providers in Huntley, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 25, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.