Provider Demographics
NPI:1063795177
Name:SVEZIA, EMILY ANN (PHARMD)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:ANN
Last Name:SVEZIA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:ANN
Other - Last Name:WHITEHEAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:375TH MEDICAL GROUP
Mailing Address - Street 2:310 WEST LOSEY STREET
Mailing Address - City:SCOTT AFB
Mailing Address - State:IL
Mailing Address - Zip Code:62225
Mailing Address - Country:US
Mailing Address - Phone:618-256-7345
Mailing Address - Fax:618-256-4603
Practice Address - Street 1:375TH MEDICAL GROUP
Practice Address - Street 2:310 WEST LOSEY STREET
Practice Address - City:SCOTT AFB
Practice Address - State:IL
Practice Address - Zip Code:62225
Practice Address - Country:US
Practice Address - Phone:618-256-7345
Practice Address - Fax:618-256-4603
Is Sole Proprietor?:No
Enumeration Date:2011-09-25
Last Update Date:2020-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010028730183500000X
IL051-294716183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist