Provider Demographics
NPI:1225704588
Name:MAISENBACH, ALEXA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ALEXA
Middle Name:
Last Name:MAISENBACH
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 1:4435 ARBOR CIR APT 23
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-2517
Mailing Address - Country:US
Mailing Address - Phone:773-682-2451
Mailing Address - Fax:
Practice Address - Street 1:4700 GILBERT AVE
Practice Address - Street 2:
Practice Address - City:WESTERN SPRINGS
Practice Address - State:IL
Practice Address - Zip Code:60558-1753
Practice Address - Country:US
Practice Address - Phone:708-246-5120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-17
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051304113183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist