Provider Demographics
NPI:1245836097
Name:YERKES, MARY C (RPH)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:C
Last Name:YERKES
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MISS
Other - First Name:MARY
Other - Middle Name:C
Other - Last Name:PLONSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:36 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:RIVER FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60305-2002
Mailing Address - Country:US
Mailing Address - Phone:708-860-8509
Mailing Address - Fax:
Practice Address - Street 1:675 W NORTH AVE
Practice Address - Street 2:
Practice Address - City:MELROSE PARK
Practice Address - State:IL
Practice Address - Zip Code:60160-1630
Practice Address - Country:US
Practice Address - Phone:708-538-4941
Practice Address - Fax:708-538-4673
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-08
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051034318183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist