Provider Demographics
NPI:1598364135
Name:DELIS, GINA
Entity Type:Individual
Prefix:DR
First Name:GINA
Middle Name:
Last Name:DELIS
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 1:9265 159TH ST
Mailing Address - Street 2:
Mailing Address - City:ORLAND HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60487-5977
Mailing Address - Country:US
Mailing Address - Phone:708-349-4340
Mailing Address - Fax:708-349-4355
Practice Address - Street 1:9265 159TH ST
Practice Address - Street 2:
Practice Address - City:ORLAND HILLS
Practice Address - State:IL
Practice Address - Zip Code:60487-5977
Practice Address - Country:US
Practice Address - Phone:708-349-4340
Practice Address - Fax:708-349-4355
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-24
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051286630183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist