Provider Demographics
NPI:1326485376
Name:GARCIA, MARY KAYE (RPH)
Entity Type:Individual
Prefix:
First Name:MARY KAYE
Middle Name:
Last Name:GARCIA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 SILVER RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60586-2902
Mailing Address - Country:US
Mailing Address - Phone:779-279-3925
Mailing Address - Fax:
Practice Address - Street 1:1800 SILVER RIDGE DR
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60586-2902
Practice Address - Country:US
Practice Address - Phone:779-279-3925
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-31
Last Update Date:2013-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051-035354183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist