Provider Demographics
NPI:1518234533
Name:LIZAK, MICHELLE LYNN (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:LYNN
Last Name:LIZAK
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:DR
Other - First Name:MICHELLE
Other - Middle Name:LYNN
Other - Last Name:LIZAK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:4740 W 95TH ST
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-2530
Mailing Address - Country:US
Mailing Address - Phone:708-425-6960
Mailing Address - Fax:708-425-9543
Practice Address - Street 1:4740 W 95TH ST
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2530
Practice Address - Country:US
Practice Address - Phone:708-425-6960
Practice Address - Fax:708-425-9543
Is Sole Proprietor?:No
Enumeration Date:2011-11-18
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.287686183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist