Provider Demographics
NPI:1124474754
Name:BAHNEAN, CLAUDIA
Entity type:Individual
Prefix:MRS
First Name:CLAUDIA
Middle Name:
Last Name:BAHNEAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13460 S ROUTE 59
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60585-5270
Mailing Address - Country:US
Mailing Address - Phone:815-577-2613
Mailing Address - Fax:815-577-2618
Practice Address - Street 1:13460 S ROUTE 59
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60585-5270
Practice Address - Country:US
Practice Address - Phone:815-577-2613
Practice Address - Fax:815-577-2618
Is Sole Proprietor?:No
Enumeration Date:2016-05-12
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.287716183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist