Provider Demographics
NPI:1558958223
Name:MAZULIS, KIMBRA LEE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KIMBRA
Middle Name:LEE
Last Name:MAZULIS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3944 N WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-3736
Mailing Address - Country:US
Mailing Address - Phone:773-279-7600
Mailing Address - Fax:
Practice Address - Street 1:3944 N WESTERN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-3736
Practice Address - Country:US
Practice Address - Phone:773-279-7600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-28
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.295845183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist