Provider Demographics
NPI:1467172304
Name:SZAPPAN, STACY (PHARMD, NTP)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:SZAPPAN
Suffix:
Gender:F
Credentials:PHARMD, NTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 S HOME AVE
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-4331
Mailing Address - Country:US
Mailing Address - Phone:847-612-6737
Mailing Address - Fax:
Practice Address - Street 1:1005 S HOME AVE
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-4331
Practice Address - Country:US
Practice Address - Phone:847-612-6737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-31
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.292126183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist