Provider Demographics
NPI:1710011879
Name:LAZARO MILLER, MICHELLE M (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:M
Last Name:LAZARO MILLER
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:823 W GUNNISON ST
Mailing Address - Street 2:#1E
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-4208
Mailing Address - Country:US
Mailing Address - Phone:773-506-9397
Mailing Address - Fax:
Practice Address - Street 1:5235 N SHERIDAN RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-2512
Practice Address - Country:US
Practice Address - Phone:773-506-9397
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051291566183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist