Provider Demographics
NPI:1477034288
Name:POLLEY, ELLYN MARIE (PHARMD)
Entity Type:Individual
Prefix:
First Name:ELLYN
Middle Name:MARIE
Last Name:POLLEY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3115 SABLE OAKS RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61704-4850
Mailing Address - Country:US
Mailing Address - Phone:309-838-0719
Mailing Address - Fax:
Practice Address - Street 1:2150 PFINGSTEN RD STE B206
Practice Address - Street 2:
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60026-1361
Practice Address - Country:US
Practice Address - Phone:847-657-6864
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-29
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.301394183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist