Individual
ELIZABETH SURYAATMAJA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
680 S RAND RD, LAKE ZURICH, IL 60047-3409
(847) 540-3052
Mailing address
680 S RAND RD, LAKE ZURICH, IL 60047-3409
(847) 540-3052
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
051290887
IL
Other
Enumeration date
12/01/2020
Last updated
09/20/2023
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