Provider Demographics
NPI:1427333962
Name:CANTLIN, ANNA M
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:M
Last Name:CANTLIN
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 1:1148 BLACK OAK DR
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-1461
Mailing Address - Country:US
Mailing Address - Phone:630-241-3507
Mailing Address - Fax:
Practice Address - Street 1:15 GRANT SQ
Practice Address - Street 2:
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-3360
Practice Address - Country:US
Practice Address - Phone:630-323-7059
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-16
Last Update Date:2011-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051-034532183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist