Provider Demographics
NPI:1164855516
Name:MATUSEVICIUTE, VIKTORIJA (RPH)
Entity Type:Individual
Prefix:
First Name:VIKTORIJA
Middle Name:
Last Name:MATUSEVICIUTE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7246 COTTONWOOD CT UNIT C
Mailing Address - Street 2:
Mailing Address - City:WILLOWBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60527-7537
Mailing Address - Country:US
Mailing Address - Phone:312-375-2248
Mailing Address - Fax:
Practice Address - Street 1:7246 COTTONWOOD CT UNIT C
Practice Address - Street 2:
Practice Address - City:WILLOWBROOK
Practice Address - State:IL
Practice Address - Zip Code:60527-7537
Practice Address - Country:US
Practice Address - Phone:312-375-2248
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-20
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051296816183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist