Healthcare Provider Details

I. General information

NPI: 1609698828
Provider Name (Legal Business Name): EVA M KOZLOWSKI PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2024
Last Update Date: 10/29/2024
Certification Date: 10/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

399 S US HIGHWAY 45
LINDENHURST IL
60046-7404
US

IV. Provider business mailing address

1070 ORCHARD POND CT
LAKE ZURICH IL
60047-2499
US

V. Phone/Fax

Practice location:
  • Phone: 847-356-2066
  • Fax:
Mailing address:
  • Phone: 773-619-7899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051.035375
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: