Healthcare Provider Details

I. General information

NPI: 1699964445
Provider Name (Legal Business Name): GUADALUPE GUZMAN PHARM,D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2007
Last Update Date: 10/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7201 W 24TH ST
NORTH RIVERSIDE IL
60546-1591
US

IV. Provider business mailing address

1531 N 21ST AVE
MELROSE PARK IL
60160-1915
US

V. Phone/Fax

Practice location:
  • Phone: 708-447-5170
  • Fax: 708-447-8490
Mailing address:
  • Phone: 773-370-0276
  • Fax: 708-447-8490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: