Healthcare Provider Details

I. General information

NPI: 1891308656
Provider Name (Legal Business Name): MARY ZUGOVIC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2020
Last Update Date: 08/31/2020
Certification Date: 08/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2855 95TH ST
NAPERVILLE IL
60564-9011
US

IV. Provider business mailing address

2855 95TH ST
NAPERVILLE IL
60564-9011
US

V. Phone/Fax

Practice location:
  • Phone: 630-904-7709
  • Fax:
Mailing address:
  • Phone: 630-904-7709
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051.303287
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: