Provider Demographics
NPI:1811278799
Name:GURGUL, ELZBIETA
Entity type:Individual
Prefix:MRS
First Name:ELZBIETA
Middle Name:
Last Name:GURGUL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3837 N PANAMA AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60634-2039
Mailing Address - Country:US
Mailing Address - Phone:773-260-2463
Mailing Address - Fax:
Practice Address - Street 1:8361 BELMONT AVE
Practice Address - Street 2:
Practice Address - City:RIVER GROVE
Practice Address - State:IL
Practice Address - Zip Code:60171-1001
Practice Address - Country:US
Practice Address - Phone:708-452-8062
Practice Address - Fax:708-452-4975
Is Sole Proprietor?:No
Enumeration Date:2011-09-06
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.293824183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist