Provider Demographics
NPI:1508453432
Name:MUNIZ, NYDIA ESTHER (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:NYDIA
Middle Name:ESTHER
Last Name:MUNIZ
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 S WELLS ST APT 2103
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-4795
Mailing Address - Country:US
Mailing Address - Phone:170-835-9418
Mailing Address - Fax:
Practice Address - Street 1:7855 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60620-5823
Practice Address - Country:US
Practice Address - Phone:773-436-6000
Practice Address - Fax:773-436-6048
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-26
Last Update Date:2020-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.260958183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist