Provider Demographics
NPI:1710582440
Name:POLIMENAKOS, MIKE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MIKE
Middle Name:
Last Name:POLIMENAKOS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11336 STRATFORD RD
Mailing Address - Street 2:
Mailing Address - City:MOKENA
Mailing Address - State:IL
Mailing Address - Zip Code:60448-2012
Mailing Address - Country:US
Mailing Address - Phone:708-334-3972
Mailing Address - Fax:
Practice Address - Street 1:11 E 14TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60411-1800
Practice Address - Country:US
Practice Address - Phone:708-756-5441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy