Provider Demographics
NPI:1790007623
Name:LIZ, DIANA V (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:V
Last Name:LIZ
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1199 E OGDEN AVE
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-8568
Mailing Address - Country:US
Mailing Address - Phone:630-357-7757
Mailing Address - Fax:630-357-8739
Practice Address - Street 1:1199 E OGDEN AVE
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-8568
Practice Address - Country:US
Practice Address - Phone:630-357-7757
Practice Address - Fax:630-357-8739
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-19
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051040642183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist