Healthcare Provider Details

I. General information

NPI: 1669753174
Provider Name (Legal Business Name): ELLEN ZISKIND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ELLEN WEISS RPH

II. Dates (important events)

Enumeration Date: 08/30/2011
Last Update Date: 08/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

442 W STATE RD
ISLAND LAKE IL
60042-8450
US

IV. Provider business mailing address

4231 N SALEM DR
ARLINGTON HEIGHTS IL
60004-7902
US

V. Phone/Fax

Practice location:
  • Phone: 847-487-2532
  • Fax: 847-487-2936
Mailing address:
  • Phone: 847-577-8812
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number51-031187
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: