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NPI Code Detail

MEDICARE: DR. MARA MICHAUD PHARM.D.

MEDICARE: DR. MARA MICHAUD PHARM.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist51296161IL
2183500000XPharmacist26025000AIN
3183500000XPharmacist17326-40WI
4183500000XPharmacistPH60336590WA

General Provider Information

NPI Number : 1972929883
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARA MICHAUD PHARM.D.
Provider Business Mailing Address
First Line : 1606 COYOTE RIDGE DR
Second Line :
City : PLAINFIELD
State : IL
Zip : 60586-2509
Country : US
Telephone Number : 312-351-0733
Fax Number :
Provider Business Practice Location Address
First Line : 2611 W CHICAGO AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60622-4519
Country : US
Telephone Number : 773-395-9900
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/16/2014
Last Update Date : 03/16/2014

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Directions to “ DR. MARA MICHAUD PHARM.D.” Practice Location

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