Provider Demographics
NPI:1962527564
Name:FITZLOFF, DEBRA MICHELE (RPH)
Entity type:Individual
Prefix:MISS
First Name:DEBRA
Middle Name:MICHELE
Last Name:FITZLOFF
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7830 GLENFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60487-5199
Mailing Address - Country:US
Mailing Address - Phone:815-806-8611
Mailing Address - Fax:
Practice Address - Street 1:6300 KINGERY HWY
Practice Address - Street 2:
Practice Address - City:WILLOWBROOK
Practice Address - State:IL
Practice Address - Zip Code:60527-2248
Practice Address - Country:US
Practice Address - Phone:630-654-2378
Practice Address - Fax:630-654-2708
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051-288132183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist