Provider Demographics
NPI:1205448503
Name:ZGLOBICA, AMANDA WERONIKA (RPH)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:WERONIKA
Last Name:ZGLOBICA
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:CVS PHARMACY
Mailing Address - Street 2:555 SOUTH RAND ROAD
Mailing Address - City:LAKE ZURICH
Mailing Address - State:IL
Mailing Address - Zip Code:60047
Mailing Address - Country:US
Mailing Address - Phone:847-726-2584
Mailing Address - Fax:
Practice Address - Street 1:CVS PHARMACY
Practice Address - Street 2:555 SOUTH RAND ROAD
Practice Address - City:LAKE ZURICH
Practice Address - State:IL
Practice Address - Zip Code:60047
Practice Address - Country:US
Practice Address - Phone:847-726-2584
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-18
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.303280183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist