Provider Demographics
NPI:1265681118
Name:BERZANSKI, ANGELA M (RPH)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:M
Last Name:BERZANSKI
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 1:25369 TAMARACK DR
Mailing Address - Street 2:
Mailing Address - City:WAUCONDA
Mailing Address - State:IL
Mailing Address - Zip Code:60084-2524
Mailing Address - Country:US
Mailing Address - Phone:847-526-7041
Mailing Address - Fax:
Practice Address - Street 1:1160 W LAKE COOK RD
Practice Address - Street 2:
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-1979
Practice Address - Country:US
Practice Address - Phone:847-537-4074
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-16
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051040370183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist