Provider Demographics
NPI:1952681579
Name:MARES, CHRISTINE ANNE (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:ANNE
Last Name:MARES
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2205 W 22ND ST
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1203
Mailing Address - Country:US
Mailing Address - Phone:630-928-0386
Mailing Address - Fax:630-928-0398
Practice Address - Street 1:2205 W 22ND ST
Practice Address - Street 2:
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-1203
Practice Address - Country:US
Practice Address - Phone:630-928-0386
Practice Address - Fax:630-928-0398
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-26
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051-288894183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist