Provider Demographics
NPI:1194125906
Name:FLIS, WERONIKA (PHARMD)
Entity type:Individual
Prefix:
First Name:WERONIKA
Middle Name:
Last Name:FLIS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14746 TRUMBULL AVE
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:IL
Mailing Address - Zip Code:60445-3623
Mailing Address - Country:US
Mailing Address - Phone:847-302-8418
Mailing Address - Fax:
Practice Address - Street 1:4800 148TH ST
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:IL
Practice Address - Zip Code:60445-3117
Practice Address - Country:US
Practice Address - Phone:708-687-1604
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-28
Last Update Date:2014-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051297784183500000X
IN26025793A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist