Provider Demographics
NPI:1801125547
Name:ZICCARELLI, ROBERTA HUNTER (MS, RPH)
Entity type:Individual
Prefix:MS
First Name:ROBERTA
Middle Name:HUNTER
Last Name:ZICCARELLI
Suffix:
Gender:F
Credentials:MS, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1725 TALLGRASS LN
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60045-4858
Mailing Address - Country:US
Mailing Address - Phone:847-773-6321
Mailing Address - Fax:
Practice Address - Street 1:8700 W BRYN MAWR AVE STE 700N
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631-3509
Practice Address - Country:US
Practice Address - Phone:773-632-1685
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-09
Last Update Date:2009-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051-0364051835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist