Healthcare Provider Details

I. General information

NPI: 1396924213
Provider Name (Legal Business Name): LYNNE A. KSIAZEK RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2007
Last Update Date: 10/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

696 NORTHWEST HWY
CARY IL
60013-2073
US

IV. Provider business mailing address

696 NORTHWEST HWY
CARY IL
60013-2073
US

V. Phone/Fax

Practice location:
  • Phone: 847-639-6352
  • Fax: 847-639-9133
Mailing address:
  • Phone: 847-639-6352
  • Fax: 847-639-9133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: