Provider Demographics
NPI:1316029978
Name:SCHULTZ, MANDI N (PHARM TECH)
Entity Type:Individual
Prefix:MS
First Name:MANDI
Middle Name:N
Last Name:SCHULTZ
Suffix:
Gender:F
Credentials:PHARM TECH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6031 W EDDY ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60634-4212
Mailing Address - Country:US
Mailing Address - Phone:773-398-8465
Mailing Address - Fax:
Practice Address - Street 1:7124 W HIGGINS AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60656-1904
Practice Address - Country:US
Practice Address - Phone:773-631-5333
Practice Address - Fax:773-763-1402
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician