Individual
KEITH MIERZWA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
966 ROUTE 59, ANTIOCH, IL 60002
(847) 395-7101
(847) 395-3112
Mailing address
966 ROUTE 59, ANTIOCH, IL 60002
(847) 395-7101
(847) 395-3112
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
051033283
IL
Other
Enumeration date
06/14/2016
Last updated
06/14/2016
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