Provider Demographics
NPI:1295016111
Name:LARMAY, MARY ELLEN A IV
Entity Type:Individual
Prefix:
First Name:MARY ELLEN
Middle Name:A
Last Name:LARMAY
Suffix:IV
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8001 N MILWAUKEE AVE
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714-2801
Mailing Address - Country:US
Mailing Address - Phone:847-583-0409
Mailing Address - Fax:847-583-0449
Practice Address - Street 1:8001 N MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714-2801
Practice Address - Country:US
Practice Address - Phone:847-583-0409
Practice Address - Fax:847-583-0449
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-06
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051034264183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist