Provider Demographics
NPI:1497037204
Name:PLATEK, DEBRA K
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:K
Last Name:PLATEK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 AZTEC CT
Mailing Address - Street 2:
Mailing Address - City:SOUTH BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-1037
Mailing Address - Country:US
Mailing Address - Phone:224-699-9469
Mailing Address - Fax:
Practice Address - Street 1:27 AZTEC CT
Practice Address - Street 2:
Practice Address - City:SOUTH BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-1037
Practice Address - Country:US
Practice Address - Phone:224-699-9469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-16
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.034803183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist