Healthcare Provider Details

I. General information

NPI: 1447195839
Provider Name (Legal Business Name): DARLEAN IRENDA MARTIN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2026
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5435 S KEDZIE AVE
CHICAGO IL
60632-2642
US

IV. Provider business mailing address

5 E 114TH ST
CHICAGO IL
60628-4921
US

V. Phone/Fax

Practice location:
  • Phone: 773-436-7396
  • Fax:
Mailing address:
  • Phone: 773-876-7455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051308551
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: