Provider Demographics
NPI:1023391802
Name:PUTOREK-MARLOWE, LYNN M (PHARMD)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:M
Last Name:PUTOREK-MARLOWE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3611 E 106TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60617-6610
Mailing Address - Country:US
Mailing Address - Phone:773-978-1988
Mailing Address - Fax:773-978-4325
Practice Address - Street 1:3611 E 106TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60617-6610
Practice Address - Country:US
Practice Address - Phone:773-978-1988
Practice Address - Fax:773-978-4325
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-27
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL51289010183500000X
IN26023014A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist