Provider Demographics
NPI:1699964445
Name:GUZMAN, GUADALUPE (PHARM,D)
Entity type:Individual
Prefix:DR
First Name:GUADALUPE
Middle Name:
Last Name:GUZMAN
Suffix:
Gender:M
Credentials:PHARM,D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1531 N 21ST AVE
Mailing Address - Street 2:
Mailing Address - City:MELROSE PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60160-1915
Mailing Address - Country:US
Mailing Address - Phone:773-370-0276
Mailing Address - Fax:708-447-8490
Practice Address - Street 1:7201 W 24TH ST
Practice Address - Street 2:
Practice Address - City:NORTH RIVERSIDE
Practice Address - State:IL
Practice Address - Zip Code:60546-1591
Practice Address - Country:US
Practice Address - Phone:708-447-5170
Practice Address - Fax:708-447-8490
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-17
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist