Provider Demographics
NPI:1730350091
Name:ADAYA, ELSIE G (RPH)
Entity type:Individual
Prefix:
First Name:ELSIE
Middle Name:G
Last Name:ADAYA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3824 N NEWLAND AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60634-2358
Mailing Address - Country:US
Mailing Address - Phone:773-545-2541
Mailing Address - Fax:
Practice Address - Street 1:GL-CMOP ROOSEVELT RD., 5TH AVE
Practice Address - Street 2:BDLG. 37 NW
Practice Address - City:HINES
Practice Address - State:IL
Practice Address - Zip Code:60141-5221
Practice Address - Country:US
Practice Address - Phone:708-786-7820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-14
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist