=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891407276
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | REBECCA WALTZER PHARMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/19/2022
-----------------------------------------------------
Last Update Date | 06/12/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 25 NORTHWEST HWY
-----------------------------------------------------
City | CARY
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60013-3017
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-516-7020
-----------------------------------------------------
Fax | 847-516-7039
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 25 NORTHWEST HWY
-----------------------------------------------------
City | CARY
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60013-3017
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-516-7020
-----------------------------------------------------
Fax | 847-516-7039
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 051297286
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------