Provider Demographics
NPI:1710618418
Name:ODISHO, ZINA (RPH)
Entity Type:Individual
Prefix:
First Name:ZINA
Middle Name:
Last Name:ODISHO
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 1:8042 KILPATRICK AVE APT 1N
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-3050
Mailing Address - Country:US
Mailing Address - Phone:773-983-6001
Mailing Address - Fax:
Practice Address - Street 1:9150 SKOKIE BLVD
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-1785
Practice Address - Country:US
Practice Address - Phone:847-673-8063
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-22
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051304590183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist