Individual
BRIAN KUBECZKO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RPH
Contact information
Practice address
8000 BROADVIEW VILLAGE SQ, BROADVIEW, IL 60155-2601
(708) 410-2957
(708) 410-2962
Mailing address
8000 BROADVIEW VILLAGE SQ, BROADVIEW, IL 60155-2601
(708) 410-2957
(708) 410-2962
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
051041018
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
051041018
STATE LICENSE
IL
Enumeration date
11/11/2011
Last updated
11/11/2011
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