Individual
EDGAR AUF DEM GRABEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
100 N RIVER RD STE G122, DES PLAINES, IL 60016-1209
(847) 581-0800
(847) 410-4910
Mailing address
6493 N NORTHWEST HWY APT 409, CHICAGO, IL 60631-1892
(708) 774-4946
Taxonomy
Speciality
Code
Description
License number
State
1835G0303X
Geriatric Pharmacist
Primary
054-035924
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
054-035924
ILLINOIS DEPARTMENT OF FINANCIAL AND PROFESSIONAL REGULATION
IL
Enumeration date
04/17/2019
Last updated
11/27/2023
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