Provider Demographics
NPI:1083243448
Name:SIASKIEWICZ, EVELYN B (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:EVELYN
Middle Name:B
Last Name:SIASKIEWICZ
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4858 S KNOX AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60632-4839
Mailing Address - Country:US
Mailing Address - Phone:773-600-9917
Mailing Address - Fax:
Practice Address - Street 1:7251 LAKE ST
Practice Address - Street 2:
Practice Address - City:RIVER FOREST
Practice Address - State:IL
Practice Address - Zip Code:60305-2238
Practice Address - Country:US
Practice Address - Phone:708-366-9960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-07
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.301691183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist