Provider Demographics
NPI:1891407276
Name:WALTZER, REBECCA (PHARMD)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:WALTZER
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 1:25 NORTHWEST HWY
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:IL
Mailing Address - Zip Code:60013-3017
Mailing Address - Country:US
Mailing Address - Phone:847-516-7020
Mailing Address - Fax:847-516-7039
Practice Address - Street 1:25 NORTHWEST HWY
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:IL
Practice Address - Zip Code:60013-3017
Practice Address - Country:US
Practice Address - Phone:847-516-7020
Practice Address - Fax:847-516-7039
Is Sole Proprietor?:No
Enumeration Date:2022-12-19
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051297286183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0Other0