Provider Demographics
NPI:1619254414
Name:LARTEY, ALBERTA
Entity Type:Individual
Prefix:
First Name:ALBERTA
Middle Name:
Last Name:LARTEY
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 1:6007 N SHERIDAN RD APT 35J
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60660-3011
Mailing Address - Country:US
Mailing Address - Phone:773-416-5762
Mailing Address - Fax:
Practice Address - Street 1:757 N MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2606
Practice Address - Country:US
Practice Address - Phone:312-664-8686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-08
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051290775183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist