Healthcare Provider Details

I. General information

NPI: 1285564740
Provider Name (Legal Business Name): MY GIA LY PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 W HARRISON ST STE 4068
CHICAGO IL
60607-3106
US

IV. Provider business mailing address

1516 W OLIVE AVE
CHICAGO IL
60660-4293
US

V. Phone/Fax

Practice location:
  • Phone: 312-942-3444
  • Fax:
Mailing address:
  • Phone: 312-563-1246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051.288400
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: