Provider Demographics
NPI:1841572880
Name:LUDCZAK, ANN B (RPH)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:B
Last Name:LUDCZAK
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 1:815 SUMMIT ST
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60120-4315
Mailing Address - Country:US
Mailing Address - Phone:847-695-5847
Mailing Address - Fax:847-697-7240
Practice Address - Street 1:815 SUMMIT ST
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60120-4315
Practice Address - Country:US
Practice Address - Phone:847-695-5847
Practice Address - Fax:847-697-7240
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051-034893183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist