Provider Demographics
NPI:1780985671
Name:SZCZYBURA, JERRY (PHARMD)
Entity type:Individual
Prefix:MR
First Name:JERRY
Middle Name:
Last Name:SZCZYBURA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91 DANADA SQ E
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60189-8484
Mailing Address - Country:US
Mailing Address - Phone:630-260-9944
Mailing Address - Fax:630-510-7123
Practice Address - Street 1:91 DANADA SQ E
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60189-8484
Practice Address - Country:US
Practice Address - Phone:630-260-9944
Practice Address - Fax:630-510-7123
Is Sole Proprietor?:No
Enumeration Date:2010-11-08
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051-286379183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist