Provider Demographics
NPI:1063877611
Name:LOZANO, EDWARD SCOTT (PHARMD)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:SCOTT
Last Name:LOZANO
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 1:2571 SUN VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:LISLE
Mailing Address - State:IL
Mailing Address - Zip Code:60532-3434
Mailing Address - Country:US
Mailing Address - Phone:630-251-2307
Mailing Address - Fax:773-792-5038
Practice Address - Street 1:5841 SOUTH MARYLAND AVE
Practice Address - Street 2:UNIVERSITY OF CHICAGO
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637-1465
Practice Address - Country:US
Practice Address - Phone:773-834-2879
Practice Address - Fax:773-702-6972
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-28
Last Update Date:2015-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0510323691835N1003X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835N1003XPharmacy Service ProvidersPharmacistNutrition Support
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist