Healthcare Provider Details

I. General information

NPI: 1639773914
Provider Name (Legal Business Name): MADELYN OLZNOI PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/26/2020
Last Update Date: 11/26/2020
Certification Date: 11/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11840 S ROUTE 59
PLAINFIELD IL
60585-5652
US

IV. Provider business mailing address

11840 S ROUTE 59
PLAINFIELD IL
60585-5652
US

V. Phone/Fax

Practice location:
  • Phone: 815-609-2451
  • Fax:
Mailing address:
  • Phone: 815-609-2451
  • Fax: 815-609-2456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051294238
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051.294238
License Number StateIL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: