Healthcare Provider Details

I. General information

NPI: 1295982981
Provider Name (Legal Business Name): MAGDALENA ZASADZKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2008
Last Update Date: 08/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 SOUTH FIFTH AVE HINES VA PHARMACY SERVICE (119)
HINES IL
60141
US

IV. Provider business mailing address

5000 SOUTH FIFTH AVE HINES VA PHARMACY SERVICE (119)
HINES IL
60141
US

V. Phone/Fax

Practice location:
  • Phone: 708-202-2488
  • Fax:
Mailing address:
  • Phone: 708-202-2488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051292702
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: