Provider Demographics
NPI:1861510349
Name:BRENIC, SUSAN ANN (RPH)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:ANN
Last Name:BRENIC
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1409 GRANVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-5013
Mailing Address - Country:US
Mailing Address - Phone:847-518-8782
Mailing Address - Fax:847-929-3126
Practice Address - Street 1:3350 N WESTERN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-6213
Practice Address - Country:US
Practice Address - Phone:773-929-1086
Practice Address - Fax:773-929-3126
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist