Provider Demographics
NPI:1700965670
Name:SALES, MARISCELLE M (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MARISCELLE
Middle Name:M
Last Name:SALES
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8849 S WASHTENAW AVE
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60805-1134
Mailing Address - Country:US
Mailing Address - Phone:708-423-8835
Mailing Address - Fax:
Practice Address - Street 1:VA PBM/SHG (119D), 1ST AVE - 1 BLOCK NORTH OF CERMAK RD
Practice Address - Street 2:BUILDING 37, ROOM 139
Practice Address - City:HINES
Practice Address - State:IL
Practice Address - Zip Code:60141
Practice Address - Country:US
Practice Address - Phone:708-786-7862
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL51287877183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist