Provider Demographics
NPI:1053906982
Name:MAZEWSKI, DOUGLAS ALOYSIUS (PHARMD)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:ALOYSIUS
Last Name:MAZEWSKI
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 S WAUKEGAN RD
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60015-5216
Mailing Address - Country:US
Mailing Address - Phone:847-272-7481
Mailing Address - Fax:
Practice Address - Street 1:16 S WAUKEGAN RD
Practice Address - Street 2:
Practice Address - City:DEERFIELD
Practice Address - State:IL
Practice Address - Zip Code:60015-5216
Practice Address - Country:US
Practice Address - Phone:847-272-7481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-03
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL049252841183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist