Provider Demographics
NPI:1699176560
Name:STACHOWICZ, ROBERT (PHARMD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:STACHOWICZ
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 1:3551 CASSOPOLIS ST
Mailing Address - Street 2:
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46514-6743
Mailing Address - Country:US
Mailing Address - Phone:574-206-0285
Mailing Address - Fax:
Practice Address - Street 1:4248 SARAGOTA AVE
Practice Address - Street 2:APT 310
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515
Practice Address - Country:US
Practice Address - Phone:847-644-3800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-10
Last Update Date:2020-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26025378A183500000X
IL051.297772183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist