Provider Demographics
NPI:1770642464
Name:DYNEK, DONNA MARIE (PHARMACY TECH)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:MARIE
Last Name:DYNEK
Suffix:
Gender:F
Credentials:PHARMACY TECH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5364 W DEVON AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60646
Mailing Address - Country:US
Mailing Address - Phone:773-774-6090
Mailing Address - Fax:773-774-7677
Practice Address - Street 1:5364 W DEVON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60646-4143
Practice Address - Country:US
Practice Address - Phone:773-774-6090
Practice Address - Fax:773-774-7677
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL43-75917183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician