Provider Demographics
NPI:1174124069
Name:SEZIBERA, DEMETRIE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:DEMETRIE
Middle Name:
Last Name:SEZIBERA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2601 S CICERO AVE
Mailing Address - Street 2:
Mailing Address - City:CICERO
Mailing Address - State:IL
Mailing Address - Zip Code:60804-3644
Mailing Address - Country:US
Mailing Address - Phone:708-652-8596
Mailing Address - Fax:
Practice Address - Street 1:2601 S CICERO AVE
Practice Address - Street 2:
Practice Address - City:CICERO
Practice Address - State:IL
Practice Address - Zip Code:60804-3644
Practice Address - Country:US
Practice Address - Phone:708-652-8596
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-05
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051302495183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist