Provider Demographics
NPI:1104107424
Name:TELWAK, ROSALIE SEMATCZYN (R PH)
Entity type:Individual
Prefix:MS
First Name:ROSALIE
Middle Name:SEMATCZYN
Last Name:TELWAK
Suffix:
Gender:F
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10131 POTTER RD
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-1546
Mailing Address - Country:US
Mailing Address - Phone:847-699-6099
Mailing Address - Fax:
Practice Address - Street 1:8001 N MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714-2801
Practice Address - Country:US
Practice Address - Phone:847-583-0409
Practice Address - Fax:847-583-0449
Is Sole Proprietor?:No
Enumeration Date:2011-08-31
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.034796183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist