Provider Demographics
NPI:1992065742
Name:ZAMBETTI, NICHOLAS J (RPH)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:J
Last Name:ZAMBETTI
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1315 N HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60506-1400
Mailing Address - Country:US
Mailing Address - Phone:630-801-5733
Mailing Address - Fax:630-801-5896
Practice Address - Street 1:1315 N HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60506-1400
Practice Address - Country:US
Practice Address - Phone:630-801-5733
Practice Address - Fax:630-801-5896
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-25
Last Update Date:2012-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051-03676183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL364195126034Medicaid