Provider Demographics
NPI:1588376743
Name:GUZMAN, ALEXANDRA LAURA (PHARMD)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:LAURA
Last Name:GUZMAN
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 1:10435 S 73RD CT
Mailing Address - Street 2:
Mailing Address - City:PALOS HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60465-2007
Mailing Address - Country:US
Mailing Address - Phone:773-885-3513
Mailing Address - Fax:
Practice Address - Street 1:9603 S PULASKI RD
Practice Address - Street 2:
Practice Address - City:EVERGREEN PARK
Practice Address - State:IL
Practice Address - Zip Code:60805-2922
Practice Address - Country:US
Practice Address - Phone:708-272-1212
Practice Address - Fax:708-272-1222
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-20
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051305288183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist