Individual
MR. GLEN LEWIS EZAKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RPH
Contact information
Practice address
820 S DAMEN AVE, (119), CHICAGO, IL 60612-3728
(312) 565-7109
(312) 569-8028
Mailing address
155 N HARBOR DR, 4402, CHICAGO, IL 60601-7364
(312) 569-7109
(312) 569-8028
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
—
IL
Other
Enumeration date
09/14/2006
Last updated
07/08/2007
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