Provider Demographics
NPI:1861565889
Name:BICKHAM, PEGGY SUSAN (PHARMD)
Entity type:Individual
Prefix:
First Name:PEGGY
Middle Name:SUSAN
Last Name:BICKHAM
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4246 ARTHUR AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60513-1914
Mailing Address - Country:US
Mailing Address - Phone:312-996-4270
Mailing Address - Fax:312-413-4146
Practice Address - Street 1:1740 W TAYLOR ST
Practice Address - Street 2:ROOM C300 MAIL CODE 883
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-7232
Practice Address - Country:US
Practice Address - Phone:312-996-4270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist