Provider Demographics
NPI:1154044816
Name:BRAUN, MARTHA LENA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:LENA
Last Name:BRAUN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:MARTHA
Other - Middle Name:LENA
Other - Last Name:GIBSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:660 W HURON HILLS TRL # R
Mailing Address - Street 2:
Mailing Address - City:ROUND LAKE HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60073-1189
Mailing Address - Country:US
Mailing Address - Phone:847-431-6799
Mailing Address - Fax:
Practice Address - Street 1:3100 W IL ROUTE 60
Practice Address - Street 2:
Practice Address - City:MUNDELEIN
Practice Address - State:IL
Practice Address - Zip Code:60060-4267
Practice Address - Country:US
Practice Address - Phone:847-367-2660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-19
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.304984183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist