Provider Demographics
NPI:1558418137
Name:MACKLIN, LARRY S (RPH)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:S
Last Name:MACKLIN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1948 BRENTWOOD RD
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-3765
Mailing Address - Country:US
Mailing Address - Phone:847-562-4901
Mailing Address - Fax:847-562-4903
Practice Address - Street 1:2750 DUNDEE RD
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-2600
Practice Address - Country:US
Practice Address - Phone:847-480-1000
Practice Address - Fax:847-480-1988
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
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
IL363069839001Medicare ID - Type Unspecified