Active NPI
Elizabeth Suryaatmaja
- Pharmacist
- Lake Zurich, IL
National Provider Identifier
1497350292
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 051290887
- Practice address
- 680 S Rand Rd
Lake Zurich, IL 60047-3409 - Phone
- (847) 540-3052
- NPI assigned
- Dec 1, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 051290887 | IL | Primary |
Addresses
Primary practice location
680 S Rand Rd
Lake Zurich, IL 60047-3409
Mailing address
680 S Rand Rd
Lake Zurich, IL 60047-3409
Phone (847) 540-3052
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 051290887 | IL | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1606780800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1695168000000",
"number": "1497350292",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "680 S RAND RD",
"city": "LAKE ZURICH",
"state": "IL",
"postal_code": "600473409",
"telephone_number": "847-540-3052"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "680 S RAND RD",
"city": "LAKE ZURICH",
"state": "IL",
"postal_code": "600473409",
"telephone_number": "847-540-3052"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SURYAATMAJA",
"first_name": "ELIZABETH",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-12-01",
"last_updated": "2023-09-20",
"certification_date": "2023-09-20",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "IL",
"license": "051290887",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lake Zurich, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.