Provider Demographics
NPI:1154281525
Name:MASTERSON, PATRICIA EILEEN
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:EILEEN
Last Name:MASTERSON
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 1:714 N THROOP ST APT 2F
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60642-5770
Mailing Address - Country:US
Mailing Address - Phone:708-305-8955
Mailing Address - Fax:
Practice Address - Street 1:2140 N HALSTED ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-4385
Practice Address - Country:US
Practice Address - Phone:312-392-5801
Practice Address - Fax:312-392-5801
Is Sole Proprietor?:No
Enumeration Date:2025-11-17
Last Update Date:2025-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.307576183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist