Provider Demographics
NPI:1932480878
Name:STOPKA, URSULA B
Entity Type:Individual
Prefix:
First Name:URSULA
Middle Name:B
Last Name:STOPKA
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 1:20096 N PARK HILL DR
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60010-3624
Mailing Address - Country:US
Mailing Address - Phone:708-692-8756
Mailing Address - Fax:
Practice Address - Street 1:9800 IRVING PARK RD
Practice Address - Street 2:
Practice Address - City:SCHILLER PARK
Practice Address - State:IL
Practice Address - Zip Code:60176-1448
Practice Address - Country:US
Practice Address - Phone:847-233-0576
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-06
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051286262183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist