Provider Demographics
NPI:1033494752
Name:MCDERMOTT, MOLLY ELIZABETH (PHARM D)
Entity Type:Individual
Prefix:MISS
First Name:MOLLY
Middle Name:ELIZABETH
Last Name:MCDERMOTT
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20010 PINE HILL RD.
Mailing Address - Street 2:14356 S. BIRCHWOOD CT. HOMER GLEN, IL
Mailing Address - City:FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:60423
Mailing Address - Country:US
Mailing Address - Phone:708-902-0117
Mailing Address - Fax:
Practice Address - Street 1:DISTRICT 222-WALGREENS
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60632
Practice Address - Country:US
Practice Address - Phone:630-910-5387
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-13
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051291463183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist