Individual
KOURTNEY FERMANICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHARM D
Contact information
Practice address
5000 S 5TH AVE, HINES, IL 60141-3030
(815) 227-0081
Mailing address
4704 RAINBOW RDG, ROCKFORD, IL 61109-3536
Taxonomy
Speciality
Code
Description
License number
State
1835C0207X
Compounded Sterile Preparations Pharmacist
Primary
05130055
IL
Other
Enumeration date
12/06/2017
Last updated
10/17/2023
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