Provider Demographics
NPI:1518561893
Name:BLONDELL, LAUREN MICHELE (PHARMD)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:MICHELE
Last Name:BLONDELL
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 1:10420 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60131-2209
Mailing Address - Country:US
Mailing Address - Phone:847-455-0160
Mailing Address - Fax:847-455-0160
Practice Address - Street 1:10420 GRAND AVE
Practice Address - Street 2:
Practice Address - City:FRANKLIN PARK
Practice Address - State:IL
Practice Address - Zip Code:60131-2209
Practice Address - Country:US
Practice Address - Phone:847-455-0160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-26
Last Update Date:2020-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.293535183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist