Healthcare Provider Details

I. General information

NPI: 1639792476
Provider Name (Legal Business Name): KATHERINE MOSIO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2020
Last Update Date: 05/27/2020
Certification Date: 05/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

722 W MAXWELL ST STE 205
CHICAGO IL
60607-5002
US

IV. Provider business mailing address

4048 FAIRWAY DR
WILMETTE IL
60091-1006
US

V. Phone/Fax

Practice location:
  • Phone: 312-355-2345
  • Fax:
Mailing address:
  • Phone: 847-962-1690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number051287837
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: