Provider Demographics
NPI:1861741514
Name:CRUZ, CASSANDRA (PHARMD)
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:
Last Name:CRUZ
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 1:6525 W DIVERSEY AVE
Mailing Address - Street 2:T-1924
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60707-2312
Mailing Address - Country:US
Mailing Address - Phone:773-804-3611
Mailing Address - Fax:
Practice Address - Street 1:6525 W DIVERSEY AVE
Practice Address - Street 2:T-1924
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60707-2312
Practice Address - Country:US
Practice Address - Phone:773-804-3611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-09
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051296189183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist