Provider Demographics
NPI:1639696198
Name:BANNOR, ZACHARY R (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ZACHARY
Middle Name:R
Last Name:BANNOR
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2035 W AUGUSTA BLVD APT 2
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-7586
Mailing Address - Country:US
Mailing Address - Phone:312-972-4731
Mailing Address - Fax:
Practice Address - Street 1:1372 N MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-9149
Practice Address - Country:US
Practice Address - Phone:773-772-0941
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-25
Last Update Date:2017-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051300601183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist