Provider Demographics
NPI:1902484819
Name:LADAS, MAGDALENE (PHARMD)
Entity Type:Individual
Prefix:
First Name:MAGDALENE
Middle Name:
Last Name:LADAS
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 1:11041 SHAW ST
Mailing Address - Street 2:
Mailing Address - City:WESTCHESTER
Mailing Address - State:IL
Mailing Address - Zip Code:60154-4131
Mailing Address - Country:US
Mailing Address - Phone:708-699-5983
Mailing Address - Fax:
Practice Address - Street 1:11041 SHAW ST
Practice Address - Street 2:
Practice Address - City:WESTCHESTER
Practice Address - State:IL
Practice Address - Zip Code:60154-4131
Practice Address - Country:US
Practice Address - Phone:708-699-5983
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-31
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051289355183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist