MEDICARE: DR. ROBERT ZAVALA PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	051038927	IL

General Provider Information

NPI Number	:	1952749558
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT ZAVALA PHARMD

Provider Business Mailing Address
First Line	:	839 N PAULINA ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-5026
Country	:	US
Telephone Number	:	773-531-2058
Fax Number	:	312-850-9522

Provider Business Practice Location Address
First Line	:	1868 S BLUE ISLAND AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60608-3013
Country	:	US
Telephone Number	:	312-993-9500
Fax Number	:	312-993-9501

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/05/2013
Last Update Date	:	06/21/2022

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