Healthcare Provider Details

I. General information

NPI: 1154639094
Provider Name (Legal Business Name): JENNIFER ANNE MCMAHON PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2010
Last Update Date: 09/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 SOUTH FIFTH AVENUE PHARMACY SERVICE (119)
HINES IL
60141
US

IV. Provider business mailing address

5000 SOUTH 5TH AVENUE PHARMACY SERVICE (119)
HINES IL
60141
US

V. Phone/Fax

Practice location:
  • Phone: 708-202-2488
  • Fax:
Mailing address:
  • Phone: 708-202-2488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051294555
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: