Provider Demographics
NPI:1841315652
Name:WADOWSKA, MAGDALENA ANNA (PHARMD)
Entity type:Individual
Prefix:
First Name:MAGDALENA
Middle Name:ANNA
Last Name:WADOWSKA
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 1:5934 W. EDDY
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60634
Mailing Address - Country:US
Mailing Address - Phone:312-952-9309
Mailing Address - Fax:
Practice Address - Street 1:3141 THATCHER AVE
Practice Address - Street 2:
Practice Address - City:RIVER GROVE
Practice Address - State:IL
Practice Address - Zip Code:60171-3432
Practice Address - Country:US
Practice Address - Phone:708-453-4465
Practice Address - Fax:708-453-4493
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist