Provider Demographics
NPI:1972929883
Name:MICHAUD, MARA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MARA
Middle Name:
Last Name:MICHAUD
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:MS
Other - First Name:MARGERY
Other - Middle Name:
Other - Last Name:HAYNES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1606 COYOTE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60586-2509
Mailing Address - Country:US
Mailing Address - Phone:312-351-0733
Mailing Address - Fax:
Practice Address - Street 1:2611 W CHICAGO AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-4519
Practice Address - Country:US
Practice Address - Phone:773-395-9900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-16
Last Update Date:2014-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL51296161183500000X
IN26025000A183500000X
WI17326-40183500000X
WAPH60336590183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist