Provider Demographics
NPI:1891765640
Name:MAG, ADRIENNE WILHELM (RPH, MBA)
Entity Type:Individual
Prefix:MS
First Name:ADRIENNE
Middle Name:WILHELM
Last Name:MAG
Suffix:
Gender:F
Credentials:RPH, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1910 S FEDERAL ST
Mailing Address - Street 2:UNIT D
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-4514
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2 E ROOSEVELT RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60605-2410
Practice Address - Country:US
Practice Address - Phone:312-212-1583
Practice Address - Fax:312-212-1588
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS11601183500000X
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist