Healthcare Provider Details

I. General information

NPI: 1497960405
Provider Name (Legal Business Name): MARLOWE MEGAN DJURIC PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

722 W MAXWELL ST SUITE 205
CHICAGO IL
60607-5002
US

IV. Provider business mailing address

722 W MAXWELL ST SUITE 205
CHICAGO IL
60607-5002
US

V. Phone/Fax

Practice location:
  • Phone: 312-355-2405
  • Fax: 312-413-3727
Mailing address:
  • Phone: 312-355-2405
  • Fax: 312-413-3727

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051-290691
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: