Basic Information
| Provider Information | |||||||||
| NPI: | 1033226501 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DIAZ | ||||||||
| FirstName: | LOURDES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6301 N SHERIDAN RD | ||||||||
| Address2: | UNIT # 5 V | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606601728 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7734656619 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3001 GREEN BAY RD | ||||||||
| Address2: | VA MEDICAL CENTER PHARMACY #119 | ||||||||
| City: | NORTH CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600643048 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8476881900 | ||||||||
| FaxNumber: | 2246103751 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/23/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 19427 | IA | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.