Provider Demographics
NPI:1770930224
Name:MAHONEY, DENNIS EDWARD (RPH, MPS)
Entity type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:EDWARD
Last Name:MAHONEY
Suffix:
Gender:M
Credentials:RPH, MPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6N690 SPLITRAIL LN
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60175-6932
Mailing Address - Country:US
Mailing Address - Phone:815-955-3126
Mailing Address - Fax:
Practice Address - Street 1:2164 BLOOMINGDALE RD
Practice Address - Street 2:
Practice Address - City:GLENDALE HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60139-1699
Practice Address - Country:US
Practice Address - Phone:630-980-4301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-14
Last Update Date:2016-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.030719183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist