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General NPI Number Information
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NPI Number | 1568869261
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Entity Type | Individual
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Provider Name | VIRGINIA DIAZ PHARM.D.
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Gender | Female
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Dates
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Enumeration Date | 11/24/2014
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Last Update Date | 11/24/2014
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Provider Practice Location Address
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Address Line | 5435 S KEDZIE AVE
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City | CHICAGO
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State | IL
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Zip | 60632-2642
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Country | US
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Telephone | 773-436-7396
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Fax |
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Provider Business Mailing Address
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Address Line | 1230 S 49TH CT
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City | CICERO
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State | IL
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Zip | 60804-1421
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Country | US
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Telephone |
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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 | 051298231
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License Number State | IL
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