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General NPI Number Information
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NPI Number | 1508537184
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Entity Type | Individual
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Provider Name | NICHOLAS ELZINGA PHARMD, RPH
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Gender | Male
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Dates
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Enumeration Date | 09/23/2021
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Last Update Date | 09/23/2021
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Provider Practice Location Address
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Address Line | 9424 S PULASKI RD
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City | OAK LAWN
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State | IL
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Zip | 60453-1935
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Country | US
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Telephone | 708-857-8274
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Fax |
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Provider Business Mailing Address
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Address Line | 1667 W OLIVE AVE APT 2
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City | CHICAGO
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State | IL
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Zip | 60660-4102
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Country | US
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Telephone | 708-990-5409
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 051304266
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License Number State | IL
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