Provider Demographics
NPI:1871193870
Name:ZERVOS, MARIA EMMANUEL
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:EMMANUEL
Last Name:ZERVOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2370 CHAMBOURD DR
Mailing Address - Street 2:
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-4658
Mailing Address - Country:US
Mailing Address - Phone:847-431-5958
Mailing Address - Fax:
Practice Address - Street 1:335 N MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:VERNON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60061-1561
Practice Address - Country:US
Practice Address - Phone:847-955-9254
Practice Address - Fax:847-955-9258
Is Sole Proprietor?:No
Enumeration Date:2020-10-28
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051036345183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist