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General NPI Number Information
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NPI Number | 1851011209
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Entity Type | Individual
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Provider Name | MARY MICHAEL
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Gender | Female
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Dates
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Enumeration Date | 08/29/2022
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Last Update Date | 08/29/2022
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Provider Practice Location Address
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Address Line | 8000 BROADVIEW VILLAGE SQ
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City | BROADVIEW
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State | IL
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Zip | 60155-2601
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Country | US
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Telephone | 708-410-2957
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Fax |
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Provider Business Mailing Address
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Address Line | 6440 BOBBY JONES LN
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City | WOODRIDGE
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State | IL
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Zip | 60517-5406
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Country | US
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Telephone | 630-362-0825
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Fax |
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 051.304825
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License Number State | IL
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