Provider Demographics
NPI:1598884777
Name:KITZMAN, SHEILA C (RPH)
Entity Type:Individual
Prefix:
First Name:SHEILA
Middle Name:C
Last Name:KITZMAN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7924 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:MACHESNEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:61115-2812
Mailing Address - Country:US
Mailing Address - Phone:815-633-3431
Mailing Address - Fax:815-636-7654
Practice Address - Street 1:7924 N 2ND ST
Practice Address - Street 2:
Practice Address - City:MACHESNEY PARK
Practice Address - State:IL
Practice Address - Zip Code:61115-2812
Practice Address - Country:US
Practice Address - Phone:815-633-3431
Practice Address - Fax:815-636-7654
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist