Provider Demographics
NPI:1194077750
Name:IBE, VIVIAN (PHARM D)
Entity type:Individual
Prefix:
First Name:VIVIAN
Middle Name:
Last Name:IBE
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 GREEN BAY ROAD
Mailing Address - Street 2:DEPT. OF PHARMACY, JAMES A. LOVELL FED. HEALTHCARE CTR.
Mailing Address - City:NORTH CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60064
Mailing Address - Country:US
Mailing Address - Phone:224-610-4390
Mailing Address - Fax:
Practice Address - Street 1:3001 GREEN BAY ROAD
Practice Address - Street 2:DEPT. OF PHARMACY, JAMES A. LOVELL FED. HEALTHCARE CTR.
Practice Address - City:NORTH CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60064
Practice Address - Country:US
Practice Address - Phone:224-610-4390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-08
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0512878971835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy