Provider Demographics
NPI:1891079463
Name:MACIASZ, DAREK GREGORY (RPH)
Entity Type:Individual
Prefix:MR
First Name:DAREK
Middle Name:GREGORY
Last Name:MACIASZ
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:999 N ELMHURST RD
Mailing Address - Street 2:
Mailing Address - City:MT PROSPECT
Mailing Address - State:IL
Mailing Address - Zip Code:60056-1135
Mailing Address - Country:US
Mailing Address - Phone:847-660-2028
Mailing Address - Fax:847-660-2025
Practice Address - Street 1:999 N ELMHURST RD
Practice Address - Street 2:
Practice Address - City:MT PROSPECT
Practice Address - State:IL
Practice Address - Zip Code:60056-1135
Practice Address - Country:US
Practice Address - Phone:847-660-2028
Practice Address - Fax:847-660-2025
Is Sole Proprietor?:No
Enumeration Date:2011-09-30
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051288015183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist