Healthcare Provider Details

I. General information

NPI: 1558177535
Provider Name (Legal Business Name): MIROSLAWA DZUL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2024
Last Update Date: 12/05/2024
Certification Date: 12/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

JEWEL-OSCO 885 E BELVEDERE RD
GRAYSLAKE IL
60030
US

IV. Provider business mailing address

575 WAIKIKI DR
DES PLAINES IL
60016-1166
US

V. Phone/Fax

Practice location:
  • Phone: 847-543-9082
  • Fax:
Mailing address:
  • Phone: 847-630-4163
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051.039371
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: