MEDICARE: RICHARD J DEBARTOLO JR. PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1835G0303X	Geriatric Pharmacist	051.297157	IL

General Provider Information

NPI Number	:	1548128275
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD J DEBARTOLO JR. PHARMD

Provider Business Mailing Address
First Line	:	2313 S MOUNT PROSPECT RD
Second Line	:
City	:	DES PLAINES
State	:	IL
Zip	:	60018-1811
Country	:	US
Telephone Number	:	888-346-4158
Fax Number	:	800-369-6512

Provider Business Practice Location Address
First Line	:	2313 S MOUNT PROSPECT RD
Second Line	:
City	:	DES PLAINES
State	:	IL
Zip	:	60018-1811
Country	:	US
Telephone Number	:	888-346-4158
Fax Number	:	800-369-6512

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/12/2026
Last Update Date	:	01/12/2026

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