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General NPI Number Information
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NPI Number | 1225007867
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Entity Type | Individual
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Provider Name | MITZI MARIE WASIK PHARMD
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Gender | Female
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Dates
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Enumeration Date | 03/16/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1801 W TAYLOR ST SUITE 4E
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City | CHICAGO
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State | IL
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Zip | 60612-4319
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Country | US
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Telephone | 312-996-2901
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Fax | 312-996-5181
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Provider Business Mailing Address
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Address Line | 833 S WOOD ST
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City | CHICAGO
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State | IL
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Zip | 60612-7229
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Country | US
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Telephone | 312-996-6110
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1835P1200X
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Taxonomy Name | Pharmacotherapy Pharmacist
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License Number |
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License Number State | IL
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