Provider Demographics
NPI:1376823096
Name:MAZIARZ, DOROTHY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:DOROTHY
Middle Name:
Last Name:MAZIARZ
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 E LAKE ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60108-1129
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:180 E LAKE ST
Practice Address - Street 2:PHARMACY
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-1129
Practice Address - Country:US
Practice Address - Phone:630-894-3276
Practice Address - Fax:630-894-1292
Is Sole Proprietor?:No
Enumeration Date:2011-08-25
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051292328183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist