Provider Demographics
NPI:1104421742
Name:RIZZO, SAM (RPH)
Entity type:Individual
Prefix:
First Name:SAM
Middle Name:
Last Name:RIZZO
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8505 NATOMA AVE
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:IL
Mailing Address - Zip Code:60459-2343
Mailing Address - Country:US
Mailing Address - Phone:708-430-0717
Mailing Address - Fax:
Practice Address - Street 1:3201 W 95TH ST
Practice Address - Street 2:
Practice Address - City:EVERGREEN PARK
Practice Address - State:IL
Practice Address - Zip Code:60805-2315
Practice Address - Country:US
Practice Address - Phone:708-499-8811
Practice Address - Fax:708-499-8816
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-02
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051-034212183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist