Provider Demographics
NPI:1205436862
Name:SCARNAVACK, LINDA LOUISE
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:LOUISE
Last Name:SCARNAVACK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10021 LANCASTER DR
Mailing Address - Street 2:
Mailing Address - City:MOKENA
Mailing Address - State:IL
Mailing Address - Zip Code:60448-7831
Mailing Address - Country:US
Mailing Address - Phone:708-307-4573
Mailing Address - Fax:
Practice Address - Street 1:4700 135TH ST
Practice Address - Street 2:
Practice Address - City:CRESTWOOD
Practice Address - State:IL
Practice Address - Zip Code:60418-1405
Practice Address - Country:US
Practice Address - Phone:708-489-6471
Practice Address - Fax:708-489-6898
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-31
Last Update Date:2020-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.287039183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist