Provider Demographics
NPI:1447608013
Name:GUTHRIE, MARY RITA
Entity type:Individual
Prefix:MRS
First Name:MARY RITA
Middle Name:
Last Name:GUTHRIE
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 1:5665 W TOUHY AVE
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714-4019
Mailing Address - Country:US
Mailing Address - Phone:847-647-1933
Mailing Address - Fax:847-647-8151
Practice Address - Street 1:5665 W TOUHY AVE
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714-4019
Practice Address - Country:US
Practice Address - Phone:847-647-1933
Practice Address - Fax:847-647-8151
Is Sole Proprietor?:No
Enumeration Date:2016-05-24
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051036774183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist