MEDICARE: LISA ZIELBAUER PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1835N1003X	Nutrition Support Pharmacist	051299680	IL
2	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	051299680	IL
3	1835P1200X	Pharmacotherapy Pharmacist	051299680	IL
4	1835P1300X	Psychiatric Pharmacist	051299680	IL
5	183700000X	Pharmacy Technician	049163521	IL
6	183500000X	Pharmacist	051299680	IL

General Provider Information

NPI Number	:	1902072242
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA ZIELBAUER PHARMD

Provider Business Mailing Address
First Line	:	32201 VILLAGE GREEN BLVD
Second Line	:
City	:	WARRENVILLE
State	:	IL
Zip	:	60555-5907
Country	:	US
Telephone Number	:	630-216-9785
Fax Number	:

Provider Business Practice Location Address
First Line	:	32201 VILLAGE GREEN BLVD
Second Line	:
City	:	WARRENVILLE
State	:	IL
Zip	:	60555-5907
Country	:	US
Telephone Number	:	630-216-9785
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/06/2008
Last Update Date	:	11/24/2020

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