Provider Demographics
NPI:1669753174
Name:ZISKIND, ELLEN
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:ZISKIND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ELLEN
Other - Middle Name:
Other - Last Name:WEISS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:4231 N SALEM DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-7902
Mailing Address - Country:US
Mailing Address - Phone:847-577-8812
Mailing Address - Fax:
Practice Address - Street 1:442 W STATE RD
Practice Address - Street 2:
Practice Address - City:ISLAND LAKE
Practice Address - State:IL
Practice Address - Zip Code:60042-8450
Practice Address - Country:US
Practice Address - Phone:847-487-2532
Practice Address - Fax:847-487-2936
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-30
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL51-031187183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist