Provider Demographics
NPI:1023307568
Name:PHILIP, JINCY N (PHARMD)
Entity type:Individual
Prefix:
First Name:JINCY
Middle Name:N
Last Name:PHILIP
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:JINCY
Other - Middle Name:P
Other - Last Name:CHEMMALAKUZHY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:3951 MICHAEL LN
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60026-1008
Mailing Address - Country:US
Mailing Address - Phone:773-793-6938
Mailing Address - Fax:
Practice Address - Street 1:3001 GREEN BAY RD
Practice Address - Street 2:
Practice Address - City:NORTH CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60064-3048
Practice Address - Country:US
Practice Address - Phone:847-688-1900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-05
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.291955183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist