Individual
BRUCE MANDEL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
10 S LEWIS AVE, WAUKEGAN, IL 60085-5121
(847) 623-9194
Mailing address
10 S LEWIS AVE, WAUKEGAN, IL 60085-5121
(847) 623-9194
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
051.035928
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
576312
EMPLOYEE ID
IL
Enumeration date
11/30/2020
Last updated
11/30/2020
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