Provider Demographics
NPI:1124226543
Name:PONTIKES, PAMALA J (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:PAMALA
Middle Name:J
Last Name:PONTIKES
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:MS
Other - First Name:PAMALA
Other - Middle Name:J
Other - Last Name:TZALLAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1960 BURTON LN
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-1572
Mailing Address - Country:US
Mailing Address - Phone:847-692-1908
Mailing Address - Fax:847-692-1908
Practice Address - Street 1:1901 W HARRISON ST
Practice Address - Street 2:DEPARTMENT OF PHARMACY
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3714
Practice Address - Country:US
Practice Address - Phone:312-864-1239
Practice Address - Fax:312-864-9222
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0051-0384261835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy