1033494752 NPI number — MISS MOLLY ELIZABETH MCDERMOTT PHARM D

Table of content: MISS MOLLY ELIZABETH MCDERMOTT PHARM D (NPI 1033494752)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033494752 NPI number — MISS MOLLY ELIZABETH MCDERMOTT PHARM D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCDERMOTT
Provider First Name:
MOLLY
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
PHARM D
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033494752
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/13/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20010 PINE HILL RD.
Provider Second Line Business Mailing Address:
14356 S. BIRCHWOOD CT. HOMER GLEN, IL
Provider Business Mailing Address City Name:
FRANKFORT
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60423
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-902-0117
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
DISTRICT 222-WALGREENS
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60632
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-910-5387
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/13/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  051291463 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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