Provider Demographics
NPI:1568803427
Name:CHIMA, EDNA
Entity Type:Individual
Prefix:DR
First Name:EDNA
Middle Name:
Last Name:CHIMA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4240 189TH ST
Mailing Address - Street 2:
Mailing Address - City:COUNTRY CLUB HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60478-5610
Mailing Address - Country:US
Mailing Address - Phone:708-798-8612
Mailing Address - Fax:
Practice Address - Street 1:8001 BROADWAY STE 202
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-5546
Practice Address - Country:US
Practice Address - Phone:219-736-8067
Practice Address - Fax:219-736-8147
Is Sole Proprietor?:No
Enumeration Date:2013-07-08
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26024879A183500000X
IL51.290949183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist