Provider Demographics
NPI:1396170114
Name:ZORA, RICHARD L (RPH)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:L
Last Name:ZORA
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 1:42970 N JANETTE ST
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:IL
Mailing Address - Zip Code:60002-8921
Mailing Address - Country:US
Mailing Address - Phone:847-395-7385
Mailing Address - Fax:
Practice Address - Street 1:42970 N JANETTE ST
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:IL
Practice Address - Zip Code:60002-8921
Practice Address - Country:US
Practice Address - Phone:847-395-7385
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-11
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.029701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist