Provider Demographics
NPI:1427212265
Name:LULINSKI, PHYLLIS LEE (RPH)
Entity Type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:LEE
Last Name:LULINSKI
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 1:1429 SCOTDALE RD
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60526-1034
Mailing Address - Country:US
Mailing Address - Phone:708-352-4759
Mailing Address - Fax:
Practice Address - Street 1:5000 5TH AVENUE
Practice Address - Street 2:VA CMOP BUILDING 37
Practice Address - City:HINES
Practice Address - State:IL
Practice Address - Zip Code:60141-5000
Practice Address - Country:US
Practice Address - Phone:708-786-7820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-10
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.024923183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist