Healthcare Provider Details

I. General information

NPI: 1639845845
Provider Name (Legal Business Name): OSCAR BUZZIO RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2021
Last Update Date: 08/18/2021
Certification Date: 08/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8639 S CICERO AVE
CHICAGO IL
60652-3505
US

IV. Provider business mailing address

1856 N MOZART ST
CHICAGO IL
60647-5112
US

V. Phone/Fax

Practice location:
  • Phone: 773-284-6332
  • Fax:
Mailing address:
  • Phone: 414-630-2431
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number15992-40
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051.298321
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: