Provider Demographics
NPI:1730464397
Name:ESCOBEDO, MARTHA (PHARMD, RPH)
Entity Type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:
Last Name:ESCOBEDO
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4385 S ARCHER AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60632-2810
Mailing Address - Country:US
Mailing Address - Phone:773-247-6804
Mailing Address - Fax:773-247-6391
Practice Address - Street 1:1164 COVINGTON DR
Practice Address - Street 2:
Practice Address - City:LEMONT
Practice Address - State:IL
Practice Address - Zip Code:60439-8590
Practice Address - Country:US
Practice Address - Phone:630-577-7846
Practice Address - Fax:630-243-7182
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-14
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051-037086183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist