Provider Demographics
NPI:1619259330
Name:ANIS, DINA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:DINA
Middle Name:
Last Name:ANIS
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 1:9245 N LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-3951
Mailing Address - Country:US
Mailing Address - Phone:312-623-3050
Mailing Address - Fax:
Practice Address - Street 1:9000 N GREENWOOD AVE
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714-1408
Practice Address - Country:US
Practice Address - Phone:847-298-3050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-20
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051289466183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist