Provider Demographics
NPI:1760217186
Name:DZIDZA, BRITTNEY B (PHARM D)
Entity type:Individual
Prefix:
First Name:BRITTNEY
Middle Name:B
Last Name:DZIDZA
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:933 E HYDE PARK BLVD APT G
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60615-2722
Mailing Address - Country:US
Mailing Address - Phone:630-506-9671
Mailing Address - Fax:
Practice Address - Street 1:933 N STATE ST APT G
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610-2842
Practice Address - Country:US
Practice Address - Phone:312-943-0671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-05
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.306453183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist