Healthcare Provider Details

I. General information

NPI: 1114438173
Provider Name (Legal Business Name): INELA MASIC PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2017
Last Update Date: 11/02/2023
Certification Date: 11/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 S 5TH AVE
HINES IL
60141-3030
US

IV. Provider business mailing address

6714 N SEELEY AVE
CHICAGO IL
60645-4907
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number051300873
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: