Provider Demographics
NPI:1952306151
Name:MONDIE, LISA C (RPH)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:C
Last Name:MONDIE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7774 S KARLOV AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60652-1225
Mailing Address - Country:US
Mailing Address - Phone:773-582-9789
Mailing Address - Fax:
Practice Address - Street 1:7845 S COTTAGE GROVE AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60619-3100
Practice Address - Country:US
Practice Address - Phone:773-873-4400
Practice Address - Fax:773-873-5635
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-15
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist