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NPI Code Detail

MEDICARE: ROBERTO CARLOS COLON

MEDICARE:   ROBERTO CARLOS COLON
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
1183500000XPharmacist051303524IL

General Provider Information

NPI Number : 1639840044
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROBERTO CARLOS COLON
Provider Business Mailing Address
First Line : 4334 S SAINT LOUIS AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60632-3528
Country : US
Telephone Number : 312-774-9136
Fax Number :
Provider Business Practice Location Address
First Line : 3943 W 47TH ST
Second Line :
City : CHICAGO
State : IL
Zip : 60632-4145
Country : US
Telephone Number : 773-927-0523
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/24/2021
Last Update Date : 09/24/2021

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Directions to “ ROBERTO CARLOS COLON ” Practice Location

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