Provider Demographics
NPI:1215210893
Name:KOLESZAR, CANDIA A (RPH)
Entity Type:Individual
Prefix:MS
First Name:CANDIA
Middle Name:A
Last Name:KOLESZAR
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 1:474 GLENDENNING PL
Mailing Address - Street 2:
Mailing Address - City:WAUKEGAN
Mailing Address - State:IL
Mailing Address - Zip Code:60087-5138
Mailing Address - Country:US
Mailing Address - Phone:847-287-6009
Mailing Address - Fax:
Practice Address - Street 1:1770 N MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-1317
Practice Address - Country:US
Practice Address - Phone:847-327-9706
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051034823183500000X
NJ15664183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist