Mara Jill Andersen, PHARMD

Key facts

NPI

1891894010

Entity type

Individual (NPI type 1)

Primary specialty

Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist 1835P0018X

License

051.287852 (IL)

Practice address

5TH Ave and Roosevelt Rd
Hines, IL 60141

Phone

(708) 202-8387

Fax

(708) 202-2011

NPI assigned

Sep 22, 2006

Sex

Female

Sole proprietor

No

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

Credentials

Doctor of Pharmacy

State licenses

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Nov 8, 2023.

{
    "created_epoch": "1158883200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1699401600000",
    "number": "1891894010",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5TH AVE AND ROOSEVELT RD",
            "city": "HINES",
            "state": "IL",
            "postal_code": "60141",
            "telephone_number": "708-202-8387",
            "fax_number": "708-202-2011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5TH AVE AND ROOSEVELT RD",
            "city": "HINES",
            "state": "IL",
            "postal_code": "60141",
            "telephone_number": "708-202-8387",
            "fax_number": "708-202-2011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSEN",
        "first_name": "MARA",
        "middle_name": "JILL",
        "name_prefix": "Dr.",
        "credential": "PHARMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-22",
        "last_updated": "2023-11-08",
        "certification_date": "2023-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1835P0018X",
            "taxonomy_group": "",
            "desc": "Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist",
            "state": "IL",
            "license": "051.287852",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hines, IL

• Danielle Alsip, PHARMD
• Kathleen Marie Ambrose, RD
• Vanessa Amelio-Hering, LCSW
• Carlos F Anchondo, LCSW
• Michael Paul Anderer, LCSW
• Andrea Lorry Andrlik, MSW, ACSW
• Tomasz P Andrusyna, PH.D.
• John A Antoine, M.D.
• Sarah Appler
• Melanie Elizabeth Arthur, OTR/L

All providers in Hines, IL · Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist in Illinois