Provider Demographics
NPI:1407970379
Name:INGENTE, BETTY N (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:BETTY
Middle Name:N
Last Name:INGENTE
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3153 W FULLERTON AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-2809
Mailing Address - Country:US
Mailing Address - Phone:773-278-6604
Mailing Address - Fax:773-395-4633
Practice Address - Street 1:3153 W FULLERTON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-2809
Practice Address - Country:US
Practice Address - Phone:773-278-6604
Practice Address - Fax:773-395-4633
Is Sole Proprietor?:No
Enumeration Date:2007-03-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL355363043002Medicaid