Provider Demographics
NPI:1275139164
Name:ABADINES, IVAN JOSEPH
Entity Type:Individual
Prefix:
First Name:IVAN JOSEPH
Middle Name:
Last Name:ABADINES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 W JACKSON BLVD APT 812
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-3146
Mailing Address - Country:US
Mailing Address - Phone:847-912-6672
Mailing Address - Fax:
Practice Address - Street 1:225 JOLIET ST
Practice Address - Street 2:
Practice Address - City:DYER
Practice Address - State:IN
Practice Address - Zip Code:46311-1709
Practice Address - Country:US
Practice Address - Phone:219-322-3014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-07
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26028851A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist