Provider Demographics
NPI:1508537184
Name:ELZINGA, NICHOLAS (PHARMD, RPH)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:ELZINGA
Suffix:
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1667 W OLIVE AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60660-4102
Mailing Address - Country:US
Mailing Address - Phone:708-990-5409
Mailing Address - Fax:
Practice Address - Street 1:9424 S PULASKI RD
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-1935
Practice Address - Country:US
Practice Address - Phone:708-857-8274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-23
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051304266183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist