Provider Demographics
NPI:1669077608
Name:MARCINIAK, MONIKA K
Entity type:Individual
Prefix:DR
First Name:MONIKA
Middle Name:K
Last Name:MARCINIAK
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 1:7030 W 75TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60638-5932
Mailing Address - Country:US
Mailing Address - Phone:708-743-3154
Mailing Address - Fax:
Practice Address - Street 1:12720 ARCHER AVE
Practice Address - Street 2:
Practice Address - City:LEMONT
Practice Address - State:IL
Practice Address - Zip Code:60439-7428
Practice Address - Country:US
Practice Address - Phone:630-243-3345
Practice Address - Fax:630-243-3350
Is Sole Proprietor?:No
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.298944183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist