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General NPI Number Information
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NPI Number | 1316004385
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Entity Type | Individual
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Provider Name | MICHAEL MA PHARM.D.
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Gender | Male
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Dates
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Enumeration Date | 01/02/2007
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Last Update Date | 10/17/2011
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Provider Practice Location Address
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Address Line | 707 SKOKIE BLVD SUITE 600
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City | NORTHBROOK
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State | IL
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Zip | 60062-2857
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Country | US
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Telephone | 708-362-9860
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Fax |
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Provider Business Mailing Address
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Address Line | 321 25TH AVE
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City | BELLWOOD
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State | IL
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Zip | 60104-1517
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Country | US
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Telephone | 708-362-9860
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Fax | 847-291-8492
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1835N0905X
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Taxonomy Name | Nuclear Pharmacist
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License Number | 55576
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 051288705
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License Number State | IL
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