Provider Demographics
NPI:1952503823
Name:SCONZA, SIRIRATNA LEALANUJA (PHARMD)
Entity Type:Individual
Prefix:
First Name:SIRIRATNA
Middle Name:LEALANUJA
Last Name:SCONZA
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 1:1209 BUSH BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60490-3276
Mailing Address - Country:US
Mailing Address - Phone:708-261-9664
Mailing Address - Fax:
Practice Address - Street 1:1177 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-3952
Practice Address - Country:US
Practice Address - Phone:630-629-5050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL51289187183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist