Provider Demographics
NPI:1730395344
Name:GERZENSHTEIN, SVETLANA (PHARMD)
Entity type:Individual
Prefix:
First Name:SVETLANA
Middle Name:
Last Name:GERZENSHTEIN
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 1:1529 S STATE ST
Mailing Address - Street 2:17J
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-3011
Mailing Address - Country:US
Mailing Address - Phone:312-913-0253
Mailing Address - Fax:
Practice Address - Street 1:251 E. HURON
Practice Address - Street 2:FEINBERG PAVILLION, LC-700
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611
Practice Address - Country:US
Practice Address - Phone:312-926-5147
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist