Provider Demographics
NPI:1952749558
Name:ZAVALA, ROBERT (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
Last Name:ZAVALA
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 1:839 N PAULINA ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-5026
Mailing Address - Country:US
Mailing Address - Phone:773-531-2058
Mailing Address - Fax:312-850-9522
Practice Address - Street 1:1868 S BLUE ISLAND AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-3013
Practice Address - Country:US
Practice Address - Phone:312-993-9500
Practice Address - Fax:312-993-9501
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-05
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051038927183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist