Healthcare Provider Details

I. General information

NPI: 1982990602
Provider Name (Legal Business Name): MASHA PECHENIK PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2011
Last Update Date: 06/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18800 RIDGE LN
MARENGO IL
60152-9123
US

IV. Provider business mailing address

18800 RIDGE LN
MARENGO IL
60152-9123
US

V. Phone/Fax

Practice location:
  • Phone: 847-890-1154
  • Fax:
Mailing address:
  • Phone: 847-890-1154
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051.293409
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: